TREATMENT 

OF 

FEVER  8c  INFLAMMATION 

S.S.  SATCHWELL 


1870 


Digitized  by  the  Internet  Archive 
in  2018  with  funding  from 
University  of  North  Carolina  at  Chapel  Hill 


https://archive.org/details/treatmentoffeverOOsatc 


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+-<S®S>4*-<S®S8~»  Hsgyji 

TREATMENT 


OF 


FEVER  AND  INFLAMMATION. 


antt  essay 


ON  THE 


TOPOGRAPHY  AND  PREVAILING  DISEASES 


OF 


JIEW  HAjHOVER  COUJNTY,  js| .  C., 

READ  BEFORE  THE  ANNUAL  MEETING  OF  THE 


ortli  Carolina  jjjrdital  jLrittj, 


HELD  AT 

WILMINGTON,  N.  C.,  MAY  25,  1870, 

BY 

S.  S.  SATOHWELL,  A.M.,  M.D. 


OF 


NEW  HANOVER  COUNTY,  N.  C. 


Published  by  order  of  the  Society. 


)Vn.M!NGTON,  K  C.  : 

ENGELHARD  &  PRICE,  STEAM  POWER  PRESS  PRINTERS, 
JOURNAL  BUILDINGS. 


I 


1870. 


ERRATA. 

f  ’WS* 

- o - 

On  page  15,  line  5,  country  should  read  county.  On  same  page  a 
period  should  occur  after  the  word  common,  in  line  8,  and  the  word 
while  should  begin  a  new  sentence.  On  same  page,  line  18,  the  word 
Trachsales  should  read  Tracheales. 

On  page  17,  line  14  from  bottom,  a  period  should  occur  after  the 
word  condition ,  and  the  word  while ,  which  follows,  should  begin  a  new 
sentence.  After  the  word  soils,  on  sime  pa^e,  line  10  from  bottom,  a 
comma  should  follow,  and  the  following  word  it  s  iould  not  begin  with 
a  capital. 

On  page  19,  line  1,  the  word  revolution  should  read  resolution. 
On  same  page,  line  15  from  bottom,  the  word  generate  should  read 
general. 

O a  page  21,  line  17  from  bottom,  the  name  Brunet  should  read 
Bennett.  On  same  page,  line  10  from  bottom,  the  word  is  should 
read  as. 

On  page  22,  line  26,  from  top,  the  word  course  should  read 
cause.  On  same  page,  line  12,  from  bottom,  a  period  should  follow 
the  word  community  and  the  following  word  more  should  begin  a 
new  sentence. 

On  page  24,  line  9,  the  word  get  should  read  yet. 

On  page  33,  line  9  from  top,  the  word  offered  should  read  op¬ 
posed.  On  same  page,  line  6  from  bottom,  the  word  offered  should  read 
opposed. 

On  page  38,  line  11,  from  top,  the  words  even  played  should  read 
employed. 

i 

On  page  39,  line  11,  from  bottom,  a  period  should  occur  after  the 
word  better,  and  the  following  word  numerous  should  begin  a  new 
sentence. 

On  page  42,  last  line,  the  word  prevented  should  read  perverted. 

On  page  44,  line  21,  from  top,  the  word  expedient  should  read 
expectant. 

On  page  49,  line  25,  from  top,  a  comma  should  take  the  place  of  a 
period  after  the  name  Manson. 

Other  typographical  errors  occur  in  different  portions  of  the  Essay, 
which  it  is  hoped  the  reader  will  recognize  to  be  such,  as  he  proceeds, 
and  make  accordingly  the  proper  allowance. 


* 


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TREATMENT 


OF 

FEVER  AND  INFLAMMATION. 


AYJST  ESSAY 

ON  THE 

TOPOGRAPHY  AND  PREVAILING  DISEASES 

OF 


JVIEW  HANOVER  COUNTY,  JN.  C., 

BEAD  BEFORE  THE  ANNUAL  MEETING  OF  THE 


HELD  AT 

WILMINGTON,  N.  0.,  MAY  25,  1870, 

BY 


S.  S.  SAT  OH  WELL, 


OF 

NEW  HANOVER  COUNTY,  N.  C. 


Published  by  order  of  the  Society. 


WWJWPN  N  P- 

ENGELHARD  &  PRICE,  STEAM  POWER  PRESS  PRINTERS, 
JOURNAL  BUILDINGS. 


1870. 


\  V\  ^ 


[APPENDIX  c.] 


ESSAY 


Read  before  the  Medical  Society  of  the  State  of  North  Carolina , 
at  Rue  Annual  Meeting  in  Wilmington ,  May  2 5th,  1870 ; 


BY 


SATCHWELL,  A.  M.,  M.  D., 


OF 

NEW  HANOVER  COUNTY,  N.  C. 

- o - 


Mr.  President: 

During  each  of  its  annual  meetings,  for  the  last  three 
years,  this  Society  has  honored  me  with  a  request  to  report 
upon  the  Topography  and  Prevailing  Diseases  of  New 
Hanover  County.  The  laborious  duties  incident  to  an  ar¬ 
duous  country  practice,  conjoined  with  those  constant  in¬ 
terruptions  and  sacrifices,  which  since  the  late  war,  more 
than  ever,  attend  the  life  of  the  true  Physician  and  Surgeon 
of  this  war-stricken  Southern  land,  have  prevented  my  res¬ 
ponse  to  this  generous  call.  And  even  now,  the  continuance 
of  these  demands  upon  me  enforce  the  conviction  that  I  can 
only  hope  to  perform  the  task  assigned  me  in  a  manner 
incomplete  and  unsatisfactory  to  myself.  To  remain  longer 
silent,  however,  with  the  invitation  still  extended,  would 
argue,  what  I  cannot  acknowledge — either  insensibility  -to 
duty  on  my  part,  or  an  indifference  to  the  high  claims,  ol 
the  medical  profession  upon  the  members  of  this  Association 
to  contribute,  each  his  mite,  to  that  medical  fabric,  broad, 
strong  and  enduring,  which  the  Society  has  been  building  up 

W _ 


j 


4 


in  North  Carolina  for  the  last  eighteen  years  of  its  exis¬ 
tence.  Nor  do  I  propose  to  allow  the  occasion  to  pass 
without  some  allusions  to  certain  well  known  heretical  doc¬ 
trines  in  relation  to  the  modern  treatment  of  congestive 
fevers,  acute  internal  inflammations  and  other  inflammatory 
diseases,  which,  through  the  medium  of  our  Transactions 
and  other  sources,  have  been  of  late  so  industriously  pro¬ 
mulgated  to  the  medical  world.  But  while,  in  the  latter 
part  of  this  paper,  I  shall  interpose  some  objections  to  the 
extreme  views  of  Todd,  Bennett  and  others  of  their  disciples 
in  this  and  other  States  and  countries,  I  may  remark  that 
my  main  purpose  is  to  perform  the  more  legitimate  work 
assigned  me  by  the  Society,  as  just  referred  to.  The  views 
I  have  to  offer  upon  points  discussed  in  this  notice  of  the 
prevailing  diseases  of  this  Southeastern  portion  of  the  Stntc, 
where  most  of  my  medical  life  has  been  spent  in  active 
practice,  are  not  claimed  to  be  novel  or  original.  They  are 
such,  however,  as  my  knowledge,  experience  and  observa¬ 
tion  enable  me  to  honestly  entertain,  feebly  though  I  shall 
express  them.  No  little  obscurity  has  always  attended  the 
cause,  nature  and  treatment  of  disease,  in  sj^ite  of  the  sure 
advances  and  brilliant  triumphs  of  the  ever-piogressive  art 
and  science  of  our  always  noble  profession.  With  all  the- 
floods  of  light  which  the  progress  in  general  culture  and 
knowledge  of  this  age  have  shed  upon  the  advancing  civili¬ 
zation  of  the  world,  it  is  strange  that  nothing  scarcely  seems 
to  be  received  as  settled  in  morals,  science,  art,  politics  or 
religion.  It  is  mainly  by  a  faithful  collection  and  compari- 
sion  of  facts  that  principles  are  established  and  medical 
science  advanced.  It  is  by  these  means  that  such  knowledge 
is  acquired  and  such  legitimate  deductions  drawn  as  will 
best  enable  us  to  attain  the  great  practical  end  of  medical 
life — correct  diagnosis  and  successful  treatment.  And  it  is 
gratifying  to  know,  that  if  we  are  to  have  in  North  Carolina 
a  Medical  Digest  worthy  to  serve  as  our  best  guide  to  prac¬ 
tice,  its  best  materials  will  be  sought  in  the.  accumulated  and 
accumulating  facts  and  contributions  of  local  Medical  History . 

TOPOGRAPHY. 

New  Hanover  County  embraces  an  area  of  about  one 
thousand  (1,000)  square  miles,  and  contains,  outside  of 
Wilmington,  a  population  of  about  twenty  thousand  (20,000) 
inhabitants.  Besides  the  Ocean  on  the  East,  it  joins  Onslow, 
Duplin,  Sampson,  Bladen,  Columbus  and  Brunswick  coun¬ 
ties.  It  presents  important  meteorological,  minerological  and 
agricultural  conditions  and  relations.  Its  climate,  natural 


resources,  products,  facilities  for  rapid  and  cheap  transpor¬ 
tation  to  the  best  markets,  and  admirable  adaptation  to  the 
production  upon  her  generally  fertile  soil,  of  almost  every 
variety  of  agricultural  and  horticultual  products,  render 
New  Hanover  not  merely  a  desirable  home  for  those  already 
here,  but  attractive  to  those  of  other  portions  of  our  own 
and  of  other  States  and  countries  beyond  the  seas,  who  seek 
new  homes  with  a  view  of  bettering  their  condition.  While 
thus  of  interest  and  attraction  in  a  commercial,  manufac¬ 
turing  and  agricultural  point  of  view,  such  is  the  range  and 
variety  of  its  climate  and  other  conditions,  that  it  gives 
origin  to  no  inconsiderable  number  and  variety  of  diseases ; 
and  the  medical  enquirer  can  here  find  much  to  interest 
him.  Large  navigable  streams,  known  as  North  East,  North 
West  and  Black  rivers,  together  with  their  numerous 
tributaries,  intersect  and  divide  up  the  county  and  empty 
their  waters  into  the  Cape  Fear  river.  These  various 
streams  present  the  usual  borders,  bottoms,  swamps,  lagoons 
and  unhealthy  sites  that  here,  as  in  similar  situations,  aro 
attended  with  those  terrestrial  exhalations,  termed  malaria 
and  productive  of  malarious  diseases.  We  have  the  customary 
intermediate  uplands,  in  some  places  constituting  extensive 
sand  ridges,  stretching,  in  some  instances,  to  long  distances. 
The  growth  of  timber  is  diversified,  consisting  principally  of 
cypress,  sweet  and  black  gum,  poplar,  oak,  hickory,  ash, 
bay,  pine,  reed  cane,  dogwood,  <fcc.,  with  the  exception  of 
her  barren  sand  ridges,  low  prairie  bottoms  and  gall-berry 
thickets,  the  soil  of  this  county  is  generally  fertile  and  finely 
adapted,  in  its  general  character,  to  the  production  of  the 
great  Southern  staple — cotton.  The  sub-soil  is  mostly  clay, 
some  of  it  silicious,  other  portions  mixed  in  these,  respects. 
A  large  belt  of  country,  known  as  Rocky  Point,  divided  by 
that  great  artery  of  our  trade,  vitality  and  prosperity,  the 
Wilmington  and  Weldon  Rail  Road,  is  as  rich  and  produc¬ 
tive  as  any  portion  of  the  State,  and  noted  for  its  advance¬ 
ment  and  prosperity  in  agriculture.  In  its  adaptation  to 
agriculture  and  horticulture,  New  Hanover  is  scarcely  ex- 
called  by  any  county  in  North  Carolina.  Good  marl  exists 
in  abundance  on  almost  every  man’s  plantation,  and  conven¬ 
ient  to  the  surface,  while  the  natural  resources  for  compost¬ 
ing  and  otherwise  enriching  the  land  universally  exists  in 
the  greatest  abundance.  Nor  is  there  wanting  evidence  that 
extensive  beds  of  phosph&tic  deposits,  .  similar  to  those 
near  Charleston,  South  Carolina,  exist  in  our  Countv.-" 
Besides  the  almost  universal  distribution  of  marl  beds  and  of 
actual  phosphatic  deposits  in  certain  localities,  very  exten- 


6 


sive  layers  of  lime  rock  exist  in  many  parts,  capable  of 
manufacturing  immense  amounts  of  excellent  lime.  The 
eyes  of  science  are  now  directed  more  earnestly  than  ever  to 
these  formations  and  remains  of  the  violent  efforts  and 
upheavings  of  nature  in  olden  times,  in  these  near  ap¬ 
proaches  to  old  ocean.  The  new  impetus  given  within  the 
last  few  years  to  the  cause  of  agriculture  in  the  County,  is 
having  the  happy  effect  of  changing  the  pursuits  of  many  of 
the  inhabitants  from  the  precarious  business  of  naval  stores, 
lumber,  shingles,  <fcc.,  to  the  surer  support  and  more  sub¬ 
stantial  prosperity  to  be  found  in  the  cultivation  of  the 
generous  soil.  Its  beneficial  results  are  seen,  too,  in  the  im¬ 
provement  of  the  health  of  the  County,  by  these  onslaughts 
upon  malaria,  which  the  clearing  of  forests,  drainage  and 
good  farming  always  make. 

The  climate  is  temperate.  The  latitude  is  between  34  and 
35  and  the  longitude  between  77  and  78  degrees,  the  mean 
temperature  being  about  50  degrees.  That  of  winter  is  about 
80,  and  that  of  summer  about  50  degrees.  The  breezes  from 
the  ocean  in  summer  are  greatly  prized,  especially  by  the 
inhabitants  in  more  immediate  proximity  to  the  coast  ;  com¬ 
mencing  about  the  middle  of  the  forenoon,  when  the  heat  of 
the  day  generally  begins  to  be  oppressive,  they  are  not  only 
cordially  welcomed,  but  are  absolutely  delicious.  Snow  is 
seldom  seen  and  rarely  remains  on  the  ground  longer  than  a 
few  hours.  So  that  while  the  climate  is  temperate  and  the 
summers  warm,  the  winters,  sometimes  variable,  are  gen¬ 
erally  mild. 

Wilmington  is  situated  on  the  East  bank  of  the  Cape 
Eear  river,  at  the  confluence  of  the  North  East  and  North 
West  rivers,  and  about  twenty-five  (25)  miles  from  the 
ocean.  Opposite  the  city  is  a  large  Island,  composed  of  the 
sedimentary  deposits  of  the  river,  and  formerly  under  suc¬ 
cessful  rice  cultivation.  The  city  is  more  elevated,  ascending 
from  the  margin  of  the  river  in  sand  hills  of  various  heights, 
the  highest  point  being  36  feet  above  the  level  of  the  sea. 
The  North  East  and  South  sides  of  the  city  are  encircled,  to 
a  great  degree,  by  creeks  and  rivulets  with  marshy  borders, 
many  of  them  have  been  filled  up  in  the  progress  of  im¬ 
provement,  but  too  many  yet  remain  for  the  good  health  of 
the  neighboring  inhabitants.  The  opposite  Island  alluded 
to,  five  miles  long  and  two  miles  wide,  is  covered  to  a  con¬ 
siderable  extent,  with  the  original  growth,  cypress,  ash, 
black  gum,  bay  and  other  trees,  with  an  undergrowth  of 
flags,  reed  and  aquatic  plants.  It  is  flooded  by  tide  water, 
except  a  small  strip  on  the  river  margin  opposite  the  city, 


7 


artificially  elevated  by  the  construction  of  wharves.  The 
same  description  is  applicable  to  the  river  margin  on  its 
Western  side  below  the  city,  the  whole  constituting  what  is 
called  “tide  swamp.”  The  soil  is  sandy,  underlaid  by  a 
limestone  formation.  The  city  is  supplied  with  water  from 
springs  and  wells,  and  much  of  it  inferior  in  quality.  This 
is  greatly  improved,  however,  in  summer,  by  the  addition  of 
ice,  large  quantities  of  which  are  consumed  in  Wilmington. 
The  filling  up  of  the  low,  swampy  places,  which  heretofore 
existed  in  some  parts  of  the  city,  has  largely  contributed  to 
the  public  health  and  encouraging  to  further  efforts  in  this 
direction.  What  influence  the  turpentine  distilleries  here 
have  upon  the  general  health  is  a  matter  of  speculation,  it  is 
true,  but  my  observations  here  and  elsewhere,  inclines  me  to 
the  conviction  that  they  are  very  desirable  auxiliary  conser¬ 
vators  of  public  health.  During  the  late  war,  it  is  conten¬ 
ded  that  it  was  more  sickly  in  autumn  in  the  vicinity  of 
turpentine  distilleries,  here  and  elsewhere  in  our  lower  Capo 
Fear,  where  their  operations  were  temporarily  suspended, 
than  it  was  before  and  since,  during  such  distillation  of  this 
extensive  commercial  staple. 

•  In  a  city  like  Wilmington,  so  promising  for  the  future,  and 
so  justly  noted  for  its  enterprise  and  increase  in  population 
and  wealth,  there  is  a  lamentable  want  of  parks  and  public 
squares.  These  necessary  appendages  to  every  city,  consti¬ 
tuting  in  fact  its  very  lungs,  were  sadly  overlooked  in  the 
earlier  days  of  Wilmington.  It  is  hoped  and  expected,  how¬ 
ever,  that  a  substitute,  to  a  great  extent,  for  this  obvkms 
defect  and  continued  want,  will  be  found  at  an  early  day,  in 
these  ornamental  grounds  and  public  squares  that  are 
springing  up  contiguous  to  the  city  upon  the  soil  of  the 
Cape  h  ear  Agricultural  Association.  This  institution,  which 
though  an  infant  in  age,  is  bounding  forth  in  giant  strides 
an  herculean  power  in  its  noble  mission  of  improving  the 
commerce,  mechanics  and  agriculture  of  Eastern  North  Caro¬ 
lina,  promises  to  supply,  very  materially,  the  comforts  and 
benefits  that  would  flow  from  the  existence  of  such  conven¬ 
iences  more  in  the  heart  of  the  city.  The  population  of 
Wilmington,  in  1850,  was  about  seven  thousand,  now  it  is 
believed  to  be  about  fifteen  thousand  inhabitants,  and  is 
therefore  the  largest  city  in  the  State. 

CAUSES — PREDISPOSING  AND  EXCITING. 

At  the  very  threshold  of.  our  Etiology  looms  above  all 
-others  for  repetition,  the  old  familiar  tale  of  bad  air  as  the 
most  potent  agent  of  disease.  It  is  the  atmosphere  of  ter- 


8 


estrial  exhalations  bearing  the  specific  poison  of  malaria  that 
makes  more  work  for  the  physicians  of  this  section,  either  in 
its  more  rapid  and  direct  or  in  its  slower  and  indirect 
influences  than  most  all  other  causes  of  disease  combined. 
Besides  the  list  of  periodical  fevers  that  its  absorption  into  the 
system  produces,  it  modifies  nearly  all  the  diseases  of  the 
different  seasons,  gives  the  character  of  periodicity  to  many, 
and  introduces  its  great  adversary,  quinine,  into  a  majority 
of  all  our  medical  prescriptions.  Malaria  has  been  a  more 
fruitful  theme  of  medical  discussions — has  been  the  occasion 
of  more  theories,  fanciful  and  reasonable,  logical  and  illogi¬ 
cal,  and  the  publication  of  more  and  larger  volumes,  than 
almost  any  subject  in  the  whole  range  of  medical  literature, 
and  yet  its  analysis  and  true  nature  continues  to  elude  inves¬ 
tigation.  Besides  the  great  practical  knowledge  of  its  effects 
and  the  fact  that  the  constituents  of  the  air  of  malarious 
localities  are  found,  Avitliout  doubt  to  be  different  from  those 
where  this  poison  does  not  exist,  but  little  is  really  known 
that  can  stand  the  test  of  our  inductive  system  of  medicine. 
Nearer  approaches,  however,  in  my  opinion,  are  being  made 
now  than  ever  before,  in  the  eager  search  after  its 
hidden  nature.  I  beliove  that  the  brilliant  triumphs  of  med¬ 
ical  progress  will  not  much  longer  permit  its  derisions  and 
reproaches  at  the  science  of  chemistry  and  medicine.  The 
footprints  of  its  haunts  are  seen  on  the  whole  habitable  globe, 
wherever  there  are  condititions  favorable  to  its  production. 
Nor  is  its  universality,  more  marked  than  the  uniform  period¬ 
icity  of  the  fevers  it  engenders.  It  prefers  such  localities 
and  regions  as  would  otherwise  be  the  choicest  of  God’s 
heritage.  Prevailing  in  all  ages,  it  is  the  same  deleterious 
agent  and  specific  poison,  except  in  degrees  of  virulence, 
whether  it  appears  upon  the  borders  of  Ganges  or  the  Nile — 
upon  the  Pontine  marshes  or  in  the  Mississippi  valley ;  upon 
the  island  of  Crete,  the  slopes  of  the  Atlantic  coast,  or  along 
the  border  and  tributaries  of  our  own  cherished  Boanoke,  Tar 
Neuse  and  Cape  Pear  rivers.  In  these  innumerable  places 
it  comes  forth  every  spring,  summer  and  fall,  in  giant 
strength  but  invisible  form.  With  stealthy  steps  it  lurks 
around  our  homes  and  altars,  producing  more  sickness  and 
mortality  in  its  immediate  or  remote  influences  than  any 
other  cause  known.  Not  alone  in  the  production  of  the 
various  forms  of  malarial  fever,  in  the  shape  of  intermittent, 
remittent  and  congestive  fevers,  are  its  ravages  recognized, 
but  in  their  sequaele  as  manifested  in  the  multifarious 
chronic  diseases  that  in  some  way  have  a  malarial  origin  and 
character  do  we  see  the  destructive  influences  of  this  agent 


9 


upon  human  health,  life  and  happiness.  Sometimes  they  are 
presented  in  the  shape  of  jaundice,  hepatitis,  and  other 
chronic  derangements  of  the  biliary  organs  so  generally 
observed  in  malarious  localities,  and  so  often  the  forerunners 
of  dropsies,  diseases  of  the  stomach,  bowels  and  other  organs. 
At  other  times  the  strength  of  the  constitution  of  some 
persons,  and  their  capacity  to  resist  for  a  longer  or  shorter 
time  malarious  influences,  enable  them  to  reside  in  such  locali¬ 
ties  without  any  special  attack  of  malarial  fever.  Few  there  are, 
however,  who,  living  in  these  regions,  do  not  present  that  sal¬ 
low  hue  and  malarious  physiognomy  which  alwaj^s  character¬ 
izes  the  inhabitants  of  malarious  regions.  In  other  instances 
these  malarial  manifestations  are  observed  in  that  large  list  of 
nervous  diseases  that  are  seen  in  those  cases  of  spinal  and 
cerebral  hemiplegia,  sciatica,  hysteria  neuralgia  and  like 
annoying  affections  which  are  more  numerous  in  malarious 
than  in  regions  free  from  its  influences.  The  literature  of 
malaria  is  destined  to  be  still  more  enriched  with  the  results 
of  the  experience  yet  to  be  proven  and  the  discoveries  yet  to 
be  made  in  its  production  of  the  family  of  nervous  and 
spinal  diseases.  But  in  whatever  form  this  prolific  cause  of 
disease  may  act,  or  however  labaryntliian  its 'ways,  it  is  the 
conclusion  of  my  long  medical  experience  in  the  malarious 
regions  of  Eastern  North  Carolina,  that  once  introduced  into 
the  system,  it  is  very  difficult  to  be  eradicated.  I  repeat  the 
important  fact,  that  residence  in  these  malarious  localities 
engenders,  sooner  or  later,  either  an  acute  attack  of  malarial 
fever  or  those  slow  derangements  of  functional  action  and  of 
the  nervous  and  vascular  systoms  which  produce  some 
chronic  lingering  disease,  or  some  gradual  undermining  of  the 
general  health,  most  generally  attended  wdtli  a  lowering  of 
the  vital  forces  and  a  depression  of  spirits.  The  inhabitants 
of  such  localities  are  noted  for  more  languor  of  body  and 
debility,  and  have  less  desire  to  enjoy  the  innocent  pleasures 
and  amusements  of  life,  than  those  residing  in  healthier 
districts. 

Hepatic  derangement  constitutes,  in  the  main,  the  basis  of 
these  troubles,  however  much  the  doctrine  may  be  ridiculed 
by  those  who  have  never  resided  in  a  malarious  region  or 
treated  a  malarial  fever.  Sometimes  they  arc. manifested  in 
that  failure  of  the  appetite,  furred  tonge,  constipated  bowels, 
feeble  pulse  and  general  debility,  with  that  saffron  hue  of 
countenance  and  dejected  eye  which  meet  us  in  our  daily 
professional  ■walks.  In  other  cases,  we  find  conjoined  to  this 
torpid  condition  of  the  liver  such  a  relaxation  of  the. alimen  ¬ 
tary  canal  and  general  debility  as  produce  or  co-exist  with 


10 


chronic  gastritis,  gasto-enteritis,  chronic  diarrhoea,  <fcc.,  that 
only  make  up  another  feature  of  this  common  disease  in 
these  lower  counties.  In  all  these  hepatic  and  splenic  affec¬ 
tions  so  intimately  related  to  those  slow  and  exhausting  com¬ 
plications,  that,  without  efficient  treatment,  gradually  under¬ 
mine  physical  health  and  destroy  human  life,  I  find  united, 
more  or  less,  depression  of  spirits  and  perversion  of  feeling, 
sometimes  even  closely  approaching  insanity.  The  residents 
of  the  purer  atmosphere  and  more  elevated  regions  of  the 
hills  and  mountains  of  our  State  are  in  their  more  elastic 
steps,  more  vigorous  frames  and  more  buoyant  spirits,  not 
only  more  healthy,  but  more  happy  and  contented  than  are 
the  same  number  of  population  in  the  swamps  and  flat  coun¬ 
ties  of  these  Eastern  shores,  whose  sallow  countenances, 
enervated  movements  and  dejected  spirits,  correspond  with 
the  enervating  influences  of  the  atmosphere  and  general 
physical  surrounding  of  the  soil.  One  general  remark  as  to 
the  treatment  of  these  troublesome  diseases.  While  the 
claims  of  mercury  are  not  to  be  ignored,  I  have  been  par¬ 
ticularly  gratified  at  the  results  of  the  use  of  nitro-muriatic 
acid.  Its  action  upon  the  liver  is  undoubted,  and  in  doses 
of  from  five  to  ten  drops,  repeated  several  times  a  day,  I  have 
found  marked  benefit  in  the  treatment  of  the  various  forms 
of  these  chronic  complaints.  I  find  it  useful,  whenever  di¬ 
gestion  is  enfebled  or  nutrition  is  impaired,  and  whether  the 
bowels  are  constipated  or  too  loose.  It  seems  to  operate, 
not  alone  as  a  stimulant  to  the  liver,  causing  generally  an 
increased  flow  of  bile,  nor  yet  alone  is  it  a  tonic,  acting  as  an 
auxiliary  to  the  functions  of  nutrition  and  assimilation,  but 
it  also  exerts,  in  my  opinion,  an  alterative  action  upon  the 
mucous  surface  of  the  stomach  and  bowels  and  upon  the 
blood.  In  jaundice,  dropsical  accumulations  and  general 
cacliepia  it  acts  well.  Of  course  I  need  not  speak  of  the  well 
known  caution  to  be  observed  of  not  administering  nitro- 
muriatic  acid  with  mercury,  from  the  poison  of  corrosive 
sublimate  formed  by  their  joint  administration  at  the  same 
time. 

In  that  form  of  chronic  malarial  diseases  known  as  obsti¬ 
nate  and  protracted  intermittent  fever,  in  which  quinine  has 
failed,  I  know  of  no  remedy  so  effective  in  breaking  up  and 
permanently  curing  the  disease,  as  a  combination  of  iron, 
quinine  and  strichnine.  When  the  chill  and  fever  continues 
to  recur  in  spite  of  all  the  quinine,  arsenic  and  other  means, 
you  will  find  a  certain  cure  and  preventative  of  the  return  in 
a  pill,  administered  three  times  a  day,  of  two  to  five  grains  of 
quinine,  a  like  quantity  of  carbonate  of  iron,  combined  with 
from  one-fifteenth  to  one-twelfth  of  a  grain  of  strichnine. 


11 


But  it  is  pleasing  to  know  that  the  cause  of  these  diseases 
can  be  modified  and  removed.  The  industry  and  science  of 
man,  which  in  all  departments  of  life  are  more  than  ever 
removing  the  difficulties  to  human  progress,  can  circumscribe 
this  fell-destroyer,  malaria,  and  not  merely  modify  his 
power,  but  rout  him  entirely  from  his  strongholds.  In  this 
very  county,  as  before  intimated,  the  advancement  of  agri¬ 
culture,  in  the  clearing  of  forests,  drainage  and  other  physical 
improvements,  have  made  and  are  still  making,  many  of  our 
hitherto  most  sickly  places  the  most  healthy.  Thus  are  the 
profits  and  improvements  in  agriculture  made  to  correspond 
with  the  improvement  of  health  and  the  prolongation  of 
human  life. 

But  there  are  other  than  physical  causes  operating  in 
this  section  with  more  than  ordinary  force  in  the  production 
of  disease.  I  refer  to  those  emotions  and  to  those  liarrassing 
cares  and  crushing  anxieties  connected  with  the  existence 
and  results  of  the  late  war.  Herein  are  causes  which  have 
already  placed  beneath  the  sod  many  of  our  oldest  citizens, 
and  which  are  preparing  others  for  premature  graves. — 
Anterior  to  that  period,  we  did  not  meet  upon  the  streets  of 
our  cities  and  on  the  byways  and  highways  so  many  witli 
haggard  eyes,  dark  frowns,  pale  faces,  and  discontented 
weariness  of  body  and  mind,  as  we  now  meet  in  increased 
numbers  at  every  turn.  Nor  did  the  physician  have  then,  as 
now,  upon  his  list  of  patients,  so  many  of  those  long  suffering 
victims  of  nervous,  dyspeptic  and  organic  diseases.  I  can 
discover  in  my  own  practice  the  cause  in  the  war  and  its 
results ;  and  the  effects  in  a  much  larger  number  of  these 
cases,  especially  of  heart  disease.  Never  have  I  seen  so 
much  comparatively  of  paralytic  disease  or  nervous  affections 
generally,  and  of  functional  and  organic  derangements  of  the 
heart,  as  I  have  witnessed  since  the  war.  These  influences 
upon  health  and  longevity  are  as  marked,  in  my  observation, 
as  they  are  lamentable.  These  causes,  however,  are  not  to 
be  mistaken  for  or  confounded  with  imperfect  food,  bad 
clothing,  violent  exposures,  &c.,  or  with  those  other  influ¬ 
ences  that  arise  from  the  atmosphere,  soil  and  other  physi¬ 
cal  characteristics  of  our  low  flat  country,  which  either  in 
their  direct  influence  upon  the  human  organization,  or  in 
their  indirect  operations,  so  act  upon  the  mental  and  physical 
powers  as  to  lower  the  action  of  the  vital  forces  and  produce 
disease.  But  these  causes  in  relation  to  the  war  are  sepa¬ 
rately  marked  by  those  profound  impressions  of  the  mmu 
and  body  that  attend  disappointments,  blasted  hopes,  woun¬ 
ded  sensibilities,  and  the  inroads  of  the  canker-worms  o 
penury  and  want.  Upon  no  class  have  these  disastious 


12 


results  of  the  war  been  so  marked  as  upon  the  medical  pro¬ 
fession.  Not  only  have  they  made  the  true  medical  man 
poorer,  from  his  humane  disposition  to  respond  to  every  call 
for  his  services,  and  to  extend  the  credit  system,  when  lie  is 
about  the  only  man  in  the  community  who  does  it  at  all,  but 
the  increased  wear  and  tear  legitimately  upon  his  mental 
and  physical  system,  in  every  respect,  since  the  war,  more 
than  that  upon  other  professional  men,  have  produced  and 
continues  to  produce  more  haggard  looks,  more  gray  hairs, 
a  greater  tendency  to  functional  and  organic  disease,  and  a 
more  general  and  premature  decay,  physically  in  him,  than  in 
the  follower  of  any  other  occupation  or  profession  among  us. 

The  changed  relations  of  our  colored  population  have  given 
a  new  interest  to  our  tables  of  health  and  mortality.  While 
the  vexed  question  of  their  capacity  for  self-government 
politically,  is  left  as  a  problem  to  be  solved  by  themselves 
and  the  politicians  and  statesmen  of  the  country,  it  has 
already  been  demonstrated,  that  in  this  period  of  their 
progress  in  freedom,  they  are,  as  a  class,  incapable  of  taking 
ordinary  care  of  their  health.  Prior  to  their  emancipation, 
under  the  kind  attention  and  fostering  care  of  their  former 
masters,  which,  in  sickness  as  in  health,  they  received,  their 
general  health  was  as  good  and  their  mortality  as  small  as 
those  of  the  whites.  But  sickness  prevails  more  generally 
now  among  them  than  the  whites,  and  death  is  making  sad 
havoc  in  their  ranks.  Disease  in  its  acute  stage  or  chronic 
form,  often  of  scrofula  and  consumption,  is  sweeping  them 
off  by  thousands,  almost  every  month,  in  these  Eastern 
Counties.  While  they  can  better  stand  the  sunshine  and 
heat  of  our  summers  than  the  whites,  they  cannot  so  well 
resist  the  rigors  of  winter,  and  the  African  succumbs  more 
readily  than  the  Caucasian  to  severe  congestions  and  high 
inflammations.  The  latter  bears  depletion  much  better,  and 
requires  less  of  stimulation.  Naturally  improvident  and  care¬ 
less,  obliged  to  assume  the  responsibility  of  providing  for 
themselves,  they  are  dying  in  large  numbers,  from  exposures 
and  from  the  want  of  cleanliness,  clothing,  food  and  medi¬ 
cines.  They  are  living  upon  good  terms,  generally,  with  the 
whites,  especially  their  former  masters ;  and  the  whites  are 
doing  all  in  their  power  to  aid  them.  But  in  consideration 
of  their  number  and  the  amount  of  their  suffering  and  sick¬ 
ness,  true  philanthropy  and  genuine  Christianity,  so  fond  of 
going  beyond  distant  seas  in  search  of  the  poor  and  idola¬ 
trous  heathen,  would  do  well  to  look  more  closely  to  our 
own  shores  as  missionary  fields  worthy  of  the  dissemination 
of  the  blessings  and  means  of  the  cause  of  missions.  Since 


emancipation,  this  :,race  (previously  so  prolific  In  num¬ 
bers,)  Lave  but  lew  children,  comparatively,  and  many  of 
them  are  given  to  the  crime  of  abortion/  The  mortality 
among  them  is  very  great  and  alarmingly  on  the  increase ; 
and  I  now  suggest  to  this  Society  the  importance  of  taking 
special  steps  to  secure  more  accurate  statistics  of  their  mor¬ 
tality.  If  this  progresses  for  the  next  fifty  years,  in  the 
same  ratio  as  it  has  done  within  the  last  five,  this  unfortu¬ 
nate  race,  destined  to  remain  among  us,  endowed  not  only 
with  the  claims  of  humanity  but  with  equal  rights  of  citi¬ 
zenship,  and  so  worthy  of  the  sympathies  and  assistance  of 
every  lover  of  humanity  and  friend  of  civilization,  will,  long 
•before  this  period  expires,  have  become  not  alone  greatly 
-degenerated  in  physical  endurance  and  longevity,  but,  sad 
-to  say,  vastly  diminished  in  numbers. 

I  will  allude  to  but  one  other  prevailing  cause  of  disease 
-among  us.  It  is  not  that  of  imperfect  food  and  clothing, 
which  since  the  war  has  been  so  seriously  felt  among 
white  and  black,  operating  as  a  constant  source  of  disease 
sand  death.  Nor  do  I  refer  to  any  every-day  exciting  cause, 
originating  from  excess  of  passion,  or  fatigue,  or  food,  or  of 
^sudden  reduction  of  temperature,  suppression  of  perspira¬ 
tion,  violent  exposure,  &c.,  but  I  refer  to  that  inlliction  upon 
the  health  of  the  community  which  is  produced  in  the 
alarming  amount  over  all  preceding  years,  of  cheap ,  Imu,  mean 
•ardent  spirits,  dispensed  by  the  multifarious  grog  shops  and 
drinking  saloons  which  have  sprung  up  and  are  springing 
up  among  us.  Nearly  all  the.  abominable,  adulterated,  in¬ 
flammatory,  poisonous  liquids  in  the  shape  of  whiskey,  gin, 
brandy,  rum,  &c.,  that  the  ingenuity  of  man  can  manufacture, 
and  which,  from  their  poisonous  and  fatal  eftects,  can  no 
longer  be  imposed  upon  the  Western,  Eastern  and  Northern 
markets,  are  now  from  their  cheapness,  and  the  too  generous 
credulity  of  Southerners,  flooded  upon  this  poverty  stricken 
land.  The  opinions  of  mankind  are  too  often  based  upon 
their  appetites  and  inclinations,  as  well  as  their  supposed 
interest.  When  there  is  a  fondness  for  drinking  ardent 
spirits,  the  thousand  excuses  and  arguments  therefor  are 
always  ready,  even  if  reason  and  experience  teach  that  sick¬ 
ness  and  death  are  the  legitimate  results.  And  they  are 
now  productive  of  a  greater  amount  of  injury,  not  onJy  m 
‘causing  disease,  but  in  aggravating  all  forms  of  fevers  and 
epidemics,  where  the  patient  has  been  previously  addicted 
to  an  excess,  than  is  generally  acknowledged  by  those 
^unacquainted  with  the  very  largo  amount  of  cheap  vhiskev 


14 


that  our  people  consume  in  this  day.  It  is  time  that  our 
law  makers  and  conservators  of  the  public  health  had  risen 
in  their  power  and  in  defiance  of  the  demands  of  the  grov¬ 
eling  appetites  and  prejudices  of  these  demoralizing  times  ; 
and  armed  with  the  panoply  of  truth,  humanity  and  science, 
had  enacted  and  enforced  more  strongly  sanitary  and 
other  laws  that  will  stay  this  tide  of  corruption,  sickness 
and  death  which  is  filling  so  many  new  made  graves,  and 
crowding  our  prisons,  hospitals  and  insane  asylums.  I  take 
the  liberty  of  appealing  to  the  Board  of  Public  Charity  of 
North  Carolina,  whose  important  services  in  the  cause  of 
humanity  in  our  State  arc  of  so  much  interest  to  all  classes 
and  occupations,  to  address  them  selves  wutli  renewed  energy 
to  this  important  feature  of  their  labors,  and  to  give  to  the 
subject  its  merited  prominence  in  their  next  report  to  the  Leg¬ 
islature.  And  I  also  appeal  to  the  proper  authorities  every¬ 
where,  to  the  municipal  authorities  of  every  town  and  city, 
to  the  board  of  commissioners  of  each  county,  to  the  trus¬ 
tees  of  the  poor,  to  the  guardians  of  public  health  all  over 
the  State,  to  men  in  office  and  out  of  office  in  every  com¬ 
munity,  who  have  bosoms  that  glow  with  the  generous  emo¬ 
tions  of  State  pride  or  warm  with  the  love  ol  humanity,  to 
gome,  one  and  all,  to  the  rescue  of  our  people  and  State  from 
this  maelstrom  of  destruction  to  the  health  and  lives  of  our 
fellow  citizens.  The  great  decrease  of  population  among  the 
colored  people  already  referred  to,  their  habits  of  indolence, 
vice  and  crime,  and  the  awful  destruction  of  human  health 
and  life  of  both  the  African  and  Caucasian  races  of  our  State, 
by  this  alaiming  increase  of  grog  shops,  liquor  saloons,  and 
whiskey  drinking,  is  enough  to  stir  the  hearts  and  nerve  the 
arms  of  every  patriot,  philanthropist  and  Christian.  No  man 
who  is  able  to  estimate  the  blessings  of  health  and  virtue, 
or  to  appreciate  the  relations  of  population  to  the  welfare  of 
the  community,  or  the  prosperity  of  the  State,  can  hesitate 
to  admit  the  magnitude  of  this  question.  Every  man  versed 
in  political  economy,  knows  the  importance  of  health  and  of  a 
good  population  and  of  good  order  to  the  industrial  pursuits 
and  general  welfare  of  every  community.  Every  legislator., 
who  loves  his  race  and  State  more  than  party,  and  who 
allows  reason,  justice  and  conscience  to  guide  him,  rather 
than  prejudice,  ignorance  or  passion,  will  not  hesitate  to 
listen  considerately  to  the  voice  of  lamentation  and  sorrow 
that  now  comes  in  pleading  tones  from  every  quarter  of  our 
State  for  more  effectual  means  and  measures,  moral  and 
legal,  to  stay  this  sweeping  tide  of  misery  and  destruction. 


PREVAILING  DISEASES. 


It  lias  been  unusually  healthy  in  this  locality,  as  I  think  it 
lias  been  generally  in  the  South  Eastern  pait  of  the  State  for 
several  years  past.  An  epidemic  of  Yariola,  in  186G,  and 
another  of  Diptheria,  in  1869,  appeared  in  this  city.  "With  these 
exceptions,  no  general  epidemic  of  the  whole  country  has 
appeared  since  the  war.  Our  endemic  diseases  of  summer  and 
fall  have  been  milder  in  form,  and  fewer  in  number  than 
common,  while  the  ravages  of  war  have  decimated  our 
numbers,  desolated  our  fields,  and  paralized  our  industrial  ope¬ 
rations,  it  would  seem  that  Providence,  in  mercy  at  the  woes 
and  sufferings  of  this  afflicted  land  during  the  last  decade 
has,  within  the  last  few  years,  interposed  His  mighty  arm  of 
deliverance  in  protecting  our  people,  in  their  noble  efforts  at 
recuperation,  from  the  usual  amount  of  sickness.  Still  there 
lias  not  been  an  entire  absence  of  the  diseases  more  peculiar 
to  the  different  seasons  and  always  of  interest  to  the  progress¬ 
ive  physician.  In  the  winter  we  have  the  customary  inflam¬ 
mations  of  the  respiratory  apparatus.  Cynance  Trachsales, 
Pneumonias,  Bronchites,  Pleurites,  &c.,  together  with 
.Rheumatisms,  Neuralgias,  and  other  diseases,  acute  and 
chronic,  of  these  Eastern  shores.  In  the  Spring  we  have 
a  continuance  of  these  inflammations  and  chronic  derange-  . 
ments,  together  with  influenzas  and  diseases  of  the  stomach 
and  bowels,  more  particularly  of  children.  It  is  in  these 
months  and  later  in  the  Summer,  that  we  have  more  preva¬ 
lent,  that  terror  of  parents  and  fruitful  source  of  mortality — 
Cholera  Infantum.  The  Spring,  too,  is  often  marked  by  an 
aggravation  of  that  numerous  class  of  nervous  diseases  in  the 
shape  of  Neuralgias,  Neuralgie  Rheumatisms,  Spinal  affections. 
Sciaticas,  and  other  nervous  affections,  which  in  their  tormen¬ 
ting  nature  love  to  linger  here  a  large  portion  of  the  whole 
year.  In  their  causes,  however  obscure,. I  do  not  consider  it 
bad  medical  logic  to  attribute  a  large  share  to  these  anoma¬ 
lous  influences  of  malaria  upon  our  nervous  organization, 
and  other  structures.  True,  the  distressing  maladies  may, 
in  this  moist  climate,  be  owing  in  no  small  degree,  to  the  influ¬ 
ence  upon  the  organization  of  those  sidden  vicissitudes  o 
temperature  observed  in  this  locality.  The  tliermometei 
.often  falls  or  rises  forty  degrees  and  upwards  m  less  than 
twenty-four  hours,  during  the  winter  and  spring,  and  I cannot 
.admit  with  some,  that  these  great  changes  are  unattended 
with  injury  to  the  health.  Still  I  believe  that  pbsen  a  ions 
which  have  been  and  will  be  made  in  the  yet  inviting  cc  o  ^ 
malaria  will  disclose  valuable  facts  in  their  relations  o  CS(j 
nervous  and  other  diseases,  which  in  their  mini  ci  am 


1G 


severity  are,  as  already  stated,  more  common  to  malarious 
than  other  localities.  1  repeat  my  conviction  that  this  taint  of 
malaria  modifies  most  our  diseases,  not  merely  those  of 
acute  inflammation,  but  is  influential  in  the  cause  and  modi¬ 
fication  of  very  many  of  that  numerous  family  of  chronic 
diseases,  splenic  and  hepatic  derangements,  subacute  inflam¬ 
mations  of  the  stomach  and  bowels,  dropsies,  stomatitis 
materna,  and  other  lingering  complaints,  more  numerous  and 
obstinate  in  malarious  than  in  more  favored  sections  as 
regards  health.  Nor  is  this  influence  of  rapid  change  of 
temperature  and  of  malarious  taint,  more  to  be  considered  in 
tracing  the  came,  than  in  adopting  the  corresponding  treat¬ 
ment,  of  this  extensive  class  of  diseases,  acute  and  chronic,  of 
malarious  portions  of  the  country.  Inflammation  of  the 
bowels,  I  have  already  remarked,  is  prominent  among  our 
ordinary  diseases  of  spring  and  summer.  I  have  known  it  to 
prevail  extensively  and  violently  here  in  an  endemic  and 
epidemic  form  also,  and  in  despite  of  the  best  medical 
tieatment,  hurrying  many  adults,  as  well  as  .children,  rapidly 
to  the  grave.  In  the  shape  of  an  epidemic  dysentery,  a 
malignant  disease  of  the  bowels  prevailed  over  a  limited 
section  of  the  county  about  one  year  ;ago.  There  were 
numerous  cases  in  and  about  the  vicinity  of  the  town  of 
*  Lillington,  in  this  county.  It  was  one  of  the  most  difficult  and 
dangerous  forms  of  bowel  disease  which  I  ever  encountered. 
It  seemed  to  select  from  preference  the  borders  and  bottoms 
.of  adjacent  streams.  Some  of  the  cases  seemed  periodical  in 
.character  giving  force  to  the  opinion  that  the  terrestrical 
•exhalations  from  these  bottoms  were  connected  with  the 
eause.  It  occurred  in  that  season  when  these  bottoms  and 
.streams  were  dry,  and  when  the  cool  nights  and  warm  days 
.denoted  those  vicissitudes  of  temperature,  that  so  sensibly 
impress  the  skin  and  produce  a  want  of  balance  in  the  circula¬ 
tion.  The  influence  in  contracting  the  capillaries  and  smaller 
.arteries,  and  impelling  an  immense  quantity  of  blood  through 
the  internal  and  lesser  resisting  vessels,  disturbing  the 
equilibrium  and  nervous  and  vascular  power,  was  likewise 
.attended  with  other  abnormal  changes  and  intestinal  irrita¬ 
tions  so  well  known  to  produce  diarrlicea  and  dysentery.  It 
.spared  neither  age  nor  sex.  It  was  generally  ushered  in  by  a 
chill,  followed  with  fever,  severe  pains  in  the  bowels,  head 
and  other  parts,  with  mucous  and  bloody  discharges.  To  a 
constant  nauseu  and  irritability  of  the  stomach,  thirst,  and 
other  ordinary  symptoms  of  bowel  complaints,  there  was 
added  early  and  rapid  prostration,  continued  high  fever,  and 
a  persistent  discharge  of  bloody  and  dark  coloured  matter. 


IT 


winch  resisted,  with  remarkable  success,  all  attempts  to  change 
its  character  or  reduce  its  quantity.  Its  general  character 
was  inflammatory  and  confined  chiefly  to  the  lower  bowels. 
As  the  type  of  the  disease  seemed  to  contra-indicate  the  use  of 
the  lancet,  I  found  a  free  administration  of  mercury,  if  the  case 
was  seen  early,  the  most  potential  remedy  in  subduing  the 
disease.  This  followed  with  such  smaller  doses  combined 
with  opiate  and  astringents  as  circumstances  indicated,  using 
sudorifics  when  they  could  be  retained,  poultices,  Ac.,  consti  ¬ 
tuted  the  main  treatment,  modified  according  to  the  varying; 
symptoms  and  changes  of  this  truly  formidable  disease.  * 

But  of  all  our  Spring  and  Summer  diseases,  none  is  so 
frequent  and  so  fatal  as  “  Cholera  Infautum,”  or  the  “  Summer 
Complaint,”  as  it  is  commonty  called,  from  its  chief  preva¬ 
lance  during  that  season.  Of  all  our  prevailing  diseases, 
none  so  stings  the  hearts  of  anxious  parents  and  friends — 
none  is  more  trying  to  the  metal  of- the  physician,  and  none- 
enters  more  largely  into  our  mortality  than  this  dreaded 
enemy  of  infantile  life.  I  may  say,  with  an  emphasis, 
that  is  based  upon  a  long  observation  of  the  sad  and  pro¬ 
verbial  want  of  proper  attention  to  the  diet  and  regimen  of 
children,  that  no  disease  demands  more  than  this  correct 
dissemination  and  intelligent  appreciation  from  the  family  as 
well  as  the  medical  attendant,  of  the  true  principles  of  food, 
clothing  and  general  hygienic  treatment  necessary  for  them. 
Insidious  in  character  often  this  scourge  of  childhood  is  too 
frequently  allowed  to  approach  a  fatal  termination,  under 
that  temporizing  domestic  management  based  on  the  want 
of  correct  views  as  to  the  cause,  nature  and  pathology  of  the 
disease.  If  the  bowels  can  only  be  checked,  the  anxious? 
mother  too  often  rests  satisfied  that  the  child  is  improving 
and  the  danger  is  over,  while  in  fact  the  slumbering  fires- 
beneath  are  only  aggravating  the  actual  condition — while  the- 
main  predisposing  cause  is  so  generally  found  in  the 
changing  temperature  and  other  conditions  of  the  atmos¬ 
phere,  modified  more  or  less  by  emanations  from  contiguous- 
soils.  It  is  to  be  regretted  that  there  does  not  prevail  a  more 
general  appreciation  of  the  laws  of  what  I  s hall  term  infant 
hygiene ,  as  related  to  the  attendant  circumstances  and  condi¬ 
tions  found — indentition,  improper  clothing,  unnecessary 
confinement  within  door  from  the  health-giving  influence  of 
the  sun  and  air,  violent  exposure  at  other  times,  bad  iood,  Ac.r 
that  not  merely  excite  but  aggravate  this  disease.  It  annu¬ 
ally  bears  its  thousands  and  tens  of  thousands  of  victims  to 
premature  graves — New  Hanover  County  and  Wilmington 
furnishing  their  sad  quota.  Let  the  suggestions  ol  common 


sense  and  of  philosophic  medicine  be  more  generally  heeded 
by  the  community,  and  more,  many  more,  of  our  children 
will  live  to  bo  sources  of  joy  to  parents  and  friends  and  bless¬ 
ings  to  the  community.  In  the  diet,  clothing  and  general 
hygiene  of  their  children,  will  not  our  mothers  consent  to 
heed  less  the  allurements  of  fashion  and  false  pride  and 
listen  more  to  the  demands  of  reason,  experience  and 
humanity?  Would  they  save  their  darling  offspring  from 
diarrhoea,  cliolara  infantum,  <fcc.  ?  If  so,  let  them  take  more 
warning  from  the  solem  truth,  which  needs  to  be  more 
profoundly  impressed  upon  them  all,  that  not  alone  do 
sudden  atmospheric  changes  and  bad  air  contribute  to  the 
production  of  these  diseases  and  of  otln  r  congestions  and 
inflammations  of  children,  but  that  their  ignorance  and  false 
pride,  in  adhering  to  practices  unreasonable  and*  customs 
ruinous  in  the  feeding  and  clothing  of  their  children,  are 
not  less  potential  in  causing  infantile  disease  and  mortality. 
Let  children  be  taken  in  good  weather,  from  the  unwhole¬ 
some  air  of  pent  up  abodes  into  the  more  invigorating  life  of 
the  out-door  air*  and  sunshine  of  Heaven.  The  accumula¬ 
tion  of  a  litl-e  dirt  and  sun-burn  will  readily  yield  to  soap,, 
water  and  time.  Let  us  teach  these  fashionable  mothers* 
how  it  is  that  their  devotion  to  low  neck  dresses,  bare  arms 
and  legs  causes  such  a  loss  of  animal  heat,  such  defective 
circulation  in  the  parts  exposed,  and  such  an  excess  of  blood 
to  the  internal  organs  as*  often  ends  in  their  congestion  and 
inflammation,  not  unfrequently  ending  in  death.  Mothers 
who  so  often  wilfully  disregard  the-  plainest  laws  of  health  in 
these  respects,  of  raising  their  children,  would  shiver  and 
suffer  from  suck  exposures  of  their  own  persons  and  oxpect 
to  be  sick  therefrom,  and  yet  they  can  stand  such  treatment 
with  far  less  danger  than  do  their  tender  infants..  The  symp¬ 
toms  of  the  formidable  disease  in  question  aire-  much  tho 
same  here  as  elsewhere  :  pulse  small  and  quick ;  fever  higher 
at  first,  assumes  the  lower  grade  as  it  progresses ;  irritability 
and  frequent  evacuations  from  the  bowels  often  attended 
with  nausea  and  vomiting ;  thirst  more  or  less;  urgent ; 
discharges,  at  first,  more  of  undigested  feculent  matter,, 
mixed  with  bile,  become  more  of  a  combination  of  mucus 
bile  and  serum,  greenish  in  color  and  offensive.  The  serous 
portion  is  more  easily  absorbed  by  the  diaper  of  the  child, 
leaving  the  green  mucus  discharges  more  visible  to  the  eye. 
When  these  discharges  change  to  those  more  putrid  exhala¬ 
tions  from  the  mucus  coat  of  the  intestines,  the  danger  is 
of  course  increased  and  the  symptoms  more  aggravated, — 
sometimes,  even  in  eases  which  seem  to  be  extreme,  the 


1  o 
-I  o 

disease  is  checked  and  tends  to  revolution  and  ends  ill 
recovery.  Too  often,  however,  do  encouraging  symptoms 
exist*  but  to  delude  and  disappoint.  The  heart  of  the  fond 
parent  is  thrilled  into  joy  to-day,  only  to  be  more  deeply 
plunged  in  anguish,  as  on  the  morrow  more  fatal  symptoms 
than  ever  supervene.  The  child,  however,  lives  on.  It  be¬ 
comes  more  and  more  reduced  to  a  mere  skeleton  ;  the  skin 
becomes  more  loose  and  flabby  ;  the  face  more  shrunken  and 
j^ale,  indicating  still  more  suffering  and  distress  ;  the  signifi¬ 
cant  turnings  of  the  head  takes  its  place  with  other  bad 
omens.  The  evacuations  from  the  bowels  in  these  fatal 
cases*  suspended  though  they  may  be  for  a  time,  break  forth 
with  renewed  power — other  untoward  symptoms  complicate 
the  case.  There  is  a  general  failure  of  the  vital  forces. 
The  disease,  in  defiance  of  all  the  powers  of  nature  and  the 
best  medical  aid,  lays  the  little  sufferer  in  the  grave.  To 
detail  the  treatment  is  but  to  repeat  an  old  familiar  tale,  as 
its  recital  by  different  persons  give  to  it  its  changing  hue  and 
various  shades.  Small  doses  of  mercury,  in  the  early  stage 
especially,  with  the  various  combinations  of  opiates,  astrin¬ 
gents  and  antacids,  I  have  found  most  beneficial.  As  the 
case  progresses,  subnitrate  of  bismuth,  Dover’s  powders, 
acetate  of  lead,  alternated  as  indicated,  with  the  various 
other  adjuvants,  external  and  internal,  with  a  constant  at¬ 
tention  to  proper  food  and  to  the  general  support  of  the 
system,  enter  into  the  established  principles  of  treatment  in 
this  section. 

Our  sickly  season  commences  in  July.  It  generally  appears 
with  so  much  regularity,  that  the  physician  expects  and 
prepares  for  it  with  as  much  certainty,  as  does  the  farmer 
arrange  his  ground  for  corn  in  the  spring,  or  for  wheat  in  tho 
fall.  It  brings  with  it  a  crop  of  diseases  more  generate  than 
any  other,  in  the  shape  of  malarial  fever.  Here  it  is  that 
until  a  few  heavy  frosts  in  the  fall  come  to  our  relief, 
our  medical  men  battle  with  and  generally  vanquish  that 
varied  type  of  fever  known  as  remittent,  intermittent  and 
congestive.  Commencing  most  generally  with  simple  inter¬ 
mittent,  it  increases  in  severity  and  obstinacy,  with  the  ad¬ 
vancing  season,  and  is  succeeded  by  remittent  or  congestive. 
Under  the  disturbing  influence  of  some  exciting  cause,  the 
intermittent  form  is  ushered  in  by  the  usual  cold  or  chilly 
stage,  followed  by  sick  stomach,  pain  in  head,  back  and 
limbs,  furred  tongue,  accession  of  fever,  &c.  This  mild  form 
is  followed  later  in  the  season  with  that  higher  grade,  of 
bilious  fever,  wherein  there  is  an  aggravation  and  exaltation 
of  all  these  symptoms.  The  system  is  more  prostrated  and 

C 


20 


restless,  pulse  quicker  and  stronger.  There'  is  more  or  less 
gastric  or  cerebral  disturbance  according  as  the  gastric  or 
cerebral  form  of  the  fever  predominates  in  different  seasons. 
Add  to  this  grade,  and  you  have  sometimes,  as  the  weather 
becomes  warmer,  the  season  more  advanced,  and  the  amount 
of  sickness  on  the  increase,  cases  of  bilious  congestive  fever. 
These  are  more  striking  still  in  violence  and  danger.  It  is 
now  that  the  faithful  interpreter  of  nature  and  of  the  laws  of 
disease  must  come  to  the  rescue.  Not  alone  with  the  reme¬ 
dies  suggested  by  enlightened  experience  and  science,  but 
with  the  caution,  firmness  and  decision  of  the  true  physician. 
With  antiphlogistic  remedies  and  antiperiodic  medicines 
must  he,  in  this  critical  hour,  battle  with  opposing  forces,  or 
else  this  high  congestion  and  raging  paroxysm  will  maintain 
the  victory  unto  death.  When  promptly  and  properly  treated 
these  autumnal  fevers,  however  variant  the  type  in  different 
seasons,  are  generally  cured.  When  neglected,  or  impro¬ 
perly  treated,  they  are  apt  either  to  terminate  fatally,  or  to 
run  into  a  slow  and  tedious,  and  sometimes  fatal,  form  of 
typhoid  fever,  more  or  less  complicating  with  the  original 
bilious  remittent.  Indeed  this  blending  of  the  types  of  fever 
either  at  first,  or  from  the  cause  just  named,  is  a  feature 
sometimes  of  our  autumnal  fevers  not  to  be  forgotten,  either 
in  diagnosis  or  treatment.  There  is  more  or  less  of  it  every 
year,  and  whenever  or  wherever  it  appears,  demands  fine 
discrimination  and  very  careful  treatment.  Leaving  out  of 
consideration  the  question  of  uncomplicated  typhoid  fever 
which  often  appears  sporadically,  and  otherwise,  in  this 
locality,  we  have  to  repeat3  that  in  whatever  form  or  compli¬ 
cation  malarial  fever  presents  itself — whether  as  a  simple 
intermittent,  remittent,  or  blending  of  types,  or  in  a  bilious 
congestive  form,  with  that  prostration,  high  fever,  delirium 
and  yellow  bilious  tinge,  peculiar  to  the  skin,  tongue  and 
eyes,  and  incident  to  the  danger  and  critical  condition  of  a 
high  grade  of  fall  fever — the  treatment  must  correspond  with 
the  indications  and  severity  of  the' case.  In  the  usual  course 
of  uncomplicated  malarial  fever,  I  have  not  only  found 
quinine  indispensable,  but  mercury  in  quantities  and  doses, 
to  suit  the  grade  of  fever,  a  most  important  auxiliary  means. 
Its  action  upon  the  liver,  which  is  so  greatly  involved  in  this 
disease,  is  very  necessary  in  those  cases,  and  I  have  seen 
deplorable  results  follow  the  neglect  of  its  use  therein.  If 
those  physicians  of  Great  Britain  and  elsewhere,  who,  by 
their  experiments  upon  dogs,  have  concluded  that  calomel 
has  no  specific  infiuence  upon  the  biliary  secretions,  and  that 
it  is  not  entitled  to  be  ranked  among  the  cholagogucs,  could 


21 


make  their  observations  upon  the  human  subject  in  the 
diseases  of  these  high  Southern  latitudes,  where  the  liver  is 
so  evidently  engorged,  and  calomel  so  strongly  indicated, 
they  might  be  induced  to  bo  less  peremptory  in  their  express¬ 
ions,  and  a  little  more  charitable  to  those  who  difler  with 
them  as  to  the  action  of  calomel  and  the  treatment  of 
disease.  I  will  discuss  this  question  at  more  length,  how¬ 
ever,  when  I  enter  upon  the  more  elaborate  subject  of  the 
treatment  of  internal  inflammations,  and  of  the  high  conges¬ 
tive  fevers  of  this  southern  latitude,  as  I  shall  do  in  my  last 
division  of  the  General  Treatment  of  Disease. 

Quinine,  in  larger  and  repeated  doses,  I  administer  with 
impunity,  whenever  its  prompt  influence  upon  the  system  is 
necessary.  An  important  disease  of  increasing  interest  in 
our  eastern  section  has  presented  me  with  a  number  of  cases 
during  the  past  few  years.  I  refer  to  it  the  more  readily 
because  in  proportion  to  its  importance,  the  allusions  to  it 
in  our  standard  books  and  journals,  are  too  brief  and  in¬ 
definite  as  respects  the  relative  value  of  its  pathology  and 
treatment.  I  allude  to  the  disease  known  as  “  Puerperal 
Anaemia,”  or  “  Stomatitis  Materna,”  or  more  popularly 
known  as  the  “  Nursing  Sore  Mouth.”  It  has  been  known  to 
prevail  as  an  epidemic  in  the  great  Mississippi  valley,  where 
it  has  mostly  existed  in  this  country.  It  seems  to  prefer 
malarious  regions.  Here,  the  cases  presented  are  sporadic 
mainly,  if  not  entirely.  This  disease  of  pregnancy  and 
childbed  seems  to  be  an  inflammation  per  se,  presenting  a 
depraved  state  of  the  blood,  attended  with  such  a  preponder¬ 
ance  of  white  corpuscles  and  deficiency  of  red  particles  as 
make  up  an  anaermic  condition,  or  Brunet’s  “  Leucaemia  of 
Pregnancy,”  as  it  is  called.  The  fact  that  it  occurs  but 
seldom  ill  the  lower  classes,  being  chiefly  confined  to  women 
of  fine  intellectual  endowments,  delicate  organizations  and 
nervous  temperaments,  who  remain  close  at  home  and  avoid 
exercise  in  the  open  air  during  pregnancy,  point  to  these 
defects  in  functional  action  and  hygienic  measures,,  and  this 
condition  of  anaermia  is  favorable  to  its  production.  In¬ 
sidious  in  its  approaches  and  deceptive  in  its  symptoms,  it 
is  often  so  mild  in  its  progress  in  early  pregnancy  as  to  fail 
to  attract  marked  attention,  or  is  mistaken  for  some  other 
disease.  Hence  weeks  and  months  of  golden  importance 
have  been  too  often  allowed  to  pass  before  proper  treatment 
is  commenced.  Then  it  becomes  so  grave  as  sometimes  to 
render  the  approach  of  the  full  term  of  gestation  truly 
alarming.  And,  occasionally  after  childbirth,  the  case  runs 
its  course  to  fatalitv.  The  importance  then  of  proper  treat- 


ment  in  the  very  incipiency  of  this  increasing  disease  among 
us  cannot  be  over  estimated.-  Taken  in  time,  suitable  medi¬ 
cation  generally  effects  a  cure.  I  have  found  the  best  treat¬ 
ment  to  consist  in  an  administration  of  those  constitutional 
remedies  found  in  chalybeate  tonics,  alteratives,  astringent 
bitters,  good  food  and  generous  support,  which  strike  at  the 
root  of  the  disease  and  effect  the  necessary  change  of  the 
fluids  from  their  abnormal  to  their  normal  condition.  The 
alarm  created  by  the  appearance  of  those  secondary  symp¬ 
toms  of  aphthous  ulcerations  appearing  on  the  tongue  and 
travelling  downwards  through  the  whole  alimentary  canal, 
and  attacking  the  mucous  surfaces  of  other  structures,  often 
attract  such  attention  and  local  treatment  to  these  coexistent 
lesions  as  to  cause  the  general  treatment  to  be  neglected 
until  too  late. 

Among  our  most  common  diseases,  and  one  that  seems  to 
be  alarmingly  on  the  increase  in  this  county,  is  “  Pulmonary 
Consumption.”  My  observations  do  not  corroborate  the 
opinion  that  either  a  moist  or  a  malarious  climate  lessens  its 
liability.  Nor  have  I  observed  any  facts  to  justify  the  too 
common  opinion  that  this  dreadful  malady  is  nearly  always 
hereditary  or  intimately  connected  with  certain  climates. 
This  error,  conjoined  with  a  popular  belief,  too  often  fixing 
itself  upon  the  attending  physician,  that  the  disease  is 
always  incurable,  is  exerting  a  deleterious  influence  upon  the 
course  of  medical  science  and  the  claims  of  humanity.  I  see 
cases  every  year  that  could  be  traced  to  neither  of  these 
causes,  but  were  dependent  upon  excess  in  sedentary  occu¬ 
pations,  too  much  confinement  within  doors,  over  anxiety  of 
mind,  bad  air  of  apartments,  disregard  of  other  hygienic 
laws,  and  more  especially  for  the  want  of  clothing  during 
our  winter  months,  and  of  sufficient  food  the  year  round, 
which  render  their  victims  so  susceptible  to  disease,  and 
which,  in  the  present  day,  causes  so  much  suffering  in  the 
community,  more  than  ever  in  this  section  in  this  want  of 
food  and  clothing,  not  alone  a  prolific  source  of  acute  affec¬ 
tions,  but  of  those  gradually  consuming  diseases  of  Scrofula 
and  Consumption.  And  when  the  important  fact  is  borne  in 
mind  that  this  frequent  disease  of  Pulmonary  Consumption 
is  so  generally  fatal,  although  dependent  so  often  upon 
causes  which  may  be  modified  and  sometimes  removed  by  an 
application  of  the  ordinary  motives  and  principles  of  pru¬ 
dence,  philanthropy  and  science,  it  is  high  time  that  our 
profession  should  more  generally  arouse,  in  conjunction  with 
other  non-professional  philanthropists  of  the  day,  and  ad¬ 
dress  themselves  with  increasing  vigor  and  faith  to  the 


23 


blessed  work  of  more  correctly  understanding  and  removing 
the  causes  of  this  most  fatal  disease  of  the  whole  country. 
I  may  remark  that  my  medical  observations  and  experience 
as  a  Surgeon  in  the  Confederate  army  during  those  late  four 
years  of  bloody  war,  justifies  me  in  the  opinion,  that  most 
of  those  who  left  their  homes  for  its  active  service  with  weak 
lungs  and  tendencies  to  “  Phthisis  Pulmonalis,”  and  even 
sometimes  incipient  tubercles  and  who  escaped  other  dangers 
and  diseases  of  that  conflict,  returned  home  either  greatly 
improved  or  entirely  restored.  I  have  nothing  new  to  offer 
as  to  treatment,  excepting  to  express  my  concurrence  with 
the  established  opinion  of  the  great  superiority  of  the 
modern  building-up  treatment  of  tonics,  alteratives,  stimu¬ 
lants,  good  food,  out  door  physical  exercise,  &c.,  over  the 
old  plan  of  diet,  depletents,  &c.  I  have  found  more  general 
good  to  follow  the  use  of  arsenic  when  the  condition  of  the 
stomach  and  bowels  will  tolerate  it,  than  from  any  other 
single  remedy.  When  the  digestive  organs  are  not  impaired  it 
seems  to  act  most  favorably  upon  the  functions  of  nutrition, 
furnishing  new  life  to  the  countenance,  more  animation  to 
the  eye,  a  better  appetite  and  more  general  strength  and 
flesh  to  the  languishing  patient.  The  recent  observations  of 
some  of  the  most  illustrious  physicians  of  Paris,  that  its  use 
in  this  disease  also  acts  happily  on  the  mucous  membranes 
of  the  lungs  are  sustained  by  my  experience.  The  inhabi¬ 
tants  of  lower  Austria,  Styria  and  the  Tyrol,  frequently  make 
use  of  arsenic  even  in  health,  because  it  enables  them  to 
breathe  more  freely  in  climbing  up  their  rugged  mountains. 

But  whether  arsenic  is  to  be  used  when  indicated,  or  the 
different  preparations  of  iodine,  iron,  vegetable  tonics,  good 
diet,  stimulants,  cod  liver  oil,  Ac.,  according  to  the  stage  of 
the  disease,  tolerance  of  the  stomach,  or  the  general  condi¬ 
tion  of  the  patient,  and  the  attendant  circumstances.  I 
choose  not  to  be  of  those  physicians  who  honestly  prefer  a 
voluntary  abandonment  of  consumptive  patients,  either  to 
the  powers  of  unaided  nature,  or  to  those  swarms  of  medical 
sharks  who,  in  their  unprincipled  course  and  with  their 
captivating  paraphernalia  of  consumptive  remedies,  infest 
every  community.  These  medical  imposters,  whose  flaming 
advertisements  are  seen  in  every  newspaper  and  public 
place,  rely  upon  meanness  for  a  living,  and  fatten  upon  the 
ill-gotten  gains  which  they  extract  from  the  unfortunate  and 
sinking  subject's  of  this  chronic  and  wasting  pulmonary 
malady,  and  who,  as  is  so  natural,  are  so  generally  liable  to 
become  the  injured  victims  of  the  glittering  hopes  held  out, 
and  the  lying  promises  made.  My  conceptions  of  duty  to 


myself  and  -of  a  common  obligation  to  my  profession  and 
humanity,  do  not  encourage  me,  of  my  own  accord,  to  abandon 
these  trying  ;&nd  touching  cases  to  the  various  snares  thus 
set  for  them,  nor  even  to  rest  satisfied  with  the  ordinary 
palliations  of  regular  treatment,  except  in  the  last  stage. 
Bather  do  I  elect  to  work  on  and  to  hope  on  in  the  faith  of 
curing  the  disease  by  legitimate  means.  While  its  relative 
mortality  is  so  fearful  and  discouraging  to  friends,  and  so 
many  in  our  own  ranks  get  much,  very  much,  of  this  vast 
amount  of  disease,  and  death  may  be  prevented  by  the  exer¬ 
cise  of  more  persistent  faith  and  more  skilful  management, 
especially  in  its  earlier  development  and  inception.  The 
progress  of  medical  science  finds  me  a  believer  in  the 
prophylactic  treatment  of  this  formidable  disease.  Judi¬ 
ciously  applied,  I  regard  it  as  not  only  capable  of  preventing 
much  suffering,  but  able  to  snatch  from  premature  graves 
many  a  darling  son  or  daughter — the  delight  of  parents  and 
the  ornament  of  the  social  circle,  and  from  the  consumptive’s 
-death,  many  a  father  and  mother — the  pride,  hope,  and 
dependence  of  the  family  and  the  joy  of  admiring  friends. 
Let  me  proceed  to  explain  :  This  thing  of  tubercle,  and  how 
it  is  deposited  in  the  lungs,  &c.,  has  long  been  unsettled. 
The  most  popular  theory  has  been  that  it  is  an  abnormal 
exudation  from  the  blood.  As  we  all  know  pathologists 
recognize  two  forms  of  tubercle,  the  gray  miliary  and  the 
yellow,  cheesy  tubercle.  Whatever  the  origin  or  nature  of 
this  tubercular  deposit,  its  tendency,  unless  removed,  is  of 
course  to  suppurative  abscess,  and  destruction  of  the  tissues 
involved,  with  a  gradual  waste  of  the  entire  physical  system. 

J.  H.  Bennett  stands  most  prominent  among  those  who 
contend  that  tubercle  is  an  exudation  or  abortive  development 
of  the  plasma  of  the  blood.  That  great  microscopist, 
Yircliow  leads  those  who  make  a  distinction  between  the 
grey  and  yellow  tubucle,  getting  a  clue  therefrom,  it  is  said, 
for  his  well  known  doctrine  of  cell  growth.  He  and  his  dis¬ 
ciples  contend  that  the  gray  tubercle  is  but  a  progressive 
development  of  cells  from  a  parent  cell,  and  that  the  yellow 
tubercle  is  only  the  result  of  a  fatty  degeneration  and  disinte¬ 
gration  of  other  tissues,  perhaps  of  the  gray  deposit  itself,  or 
of  pus,  or  of  carcinoma  and  the  like.  They  hold  that  this 
gray  tubercle  may  cause  what  they  denominate  acute 
phthisis,  with  constitutional  symptoms,  not  unlike  those  of 
typhus  fever,  for  which  it  has  been  sometimes  mistaken,  but 
that  this  form  of  pulmonary  disease  is  unlike  that  old 
fashioned  form  of  chronic  Phthisis  Pulmonalis,  which  by  its 
slow  and  wasting  ravages  daily  lays  its  thousands  in  tho 


grate,  and  that  is'  caused  by  the  yellow  or  cheesy  tubercular* 
deposits.  It  is  contended  that  this  yellow  material  comes, 
not  as  an  exudation  from  an  altered  state  of  the  blood,  but 
from  the  -worn  out  epithelial  cells  of  the  air  vesicles.  That 
instead  of  being  removed  by  the  vital  actions  of  the  part, 
they  are  allowed  to  remain  as  sources  of  irritation,  and  by 
gradual  accumulation  render  that  portion  of  the  lung  unfit 
for  respiration.  The  advocates  of  the  epithelial  origin  of  the 
common  yellow  tubercle,  argue  that  tlieir  theory  explains 
satisfactorily  difficulties  and  problems  that  cannot  be  solved 
by  the  admission  of  the  doctrine  of  exudation  from  the 
blood — that  the  advocates  of  the  latter  cannot  show  how  it 
is  that  these  cheesy  deposits  are  so  uniformly  found  on  the 
apex  of  the  lungs,  and  are  so  long  restricted  to  one  side  of 
the  lungs,  after  being  deposited.  They  contend  that  no 
chemical  or  microscopic  test  has  ever  discovered  any  proof 
of  that  peculiar  morbid  condition  or  alteration  of  the  blood 
claimed  as  necessary  to  the  production  of  the  deposit  in 
question.  Virchow  says  that  he  “  found  a  series  of  tubercular 
deposits  in  different  organs,  never  at  any  time  exhibited  a 
discernible  exudation,  but  always,  during  the  whole  course 
of  their  development,  presented  organized  elements,  without 
its  being  possible  to  observe  either  in  them,  or  before  they 
existed,  any  stage  in  which  amorphous,  shapeless  matter 
was-  present.”  He  ^lso  says  that  “  nuclei  and  cells  are  found, 
in  great  abundance,  though  they  afterwards  break  up,  and 
directly  supply  the  material  for  the  final  accumulation  of 
cheesy  substance.”  Upon  such  and  similar  grounds  are 
founded  their  argument,  that  this  material  is  not  a  morbid 
product  of  exudation  from  the  blood,  but  that  it  is  more  of  a 
normal  constituent,  which,  failing  to  be  excreted  in  time, 
remains  as  a  foreign  body  to  be  softened  and  excreted  by 
expectoration  or  otherwise  removed  from  the  system.  They 
reason  that  this  deposit  is  not  found  in  those  lower  and 
more  depending  portions  of  the  lungs  where  movement  is  so 
free  and  easy,  but  in  those  upper  parts  where  the  bony 
structures  and  harder  parietes  do  not  admit  of  that  full 
motion  and  play  of  the  lungs  necessary  to  the  full  ingress 
and  egress  of  air.  It  is  in  these  portions  of  imperfect  and 
restricted  respiratory  action,  except  at  great  muscular  effoit, 
that  these  deposits  are  almost  wholly  found,  and  it  is  held 
that  these  accumulations  Would  never  occur  if  there  was 
sufficient  force  to  prevent  it.  It  is  claimed  that  this  loicc  01 
agency  exists  in  the  pressure  of  the  air  vesicles,  and  in  t  re 
power  of  respiration  to  press  out  tlieir  contents,  and  t  1a . 
such  power  mainly  depends  upon  the  vigor  of  the  icspnatoiy 


2  G 


action.  That  while  the  peristaltic  action  and  passing  sub-* 
stances  of  the  alimentary  canal  are  competent  to  throw  off 
from  the  mucous  surface  the  worn  out  epithelium,  the  ciliary 
currents  of  the  bronchi  are  not  always  thus  competent,  and 
that  as  an  auxiliary  therefore,  a  free  and  full  action  of  the 
respiratory  apparatus  is  necessary.  Adducing  such  reasons 
in  support  of  their  conclusions,  those  men  not  only  contend 
that  consumption  is  curable,  but,  that  as  a  disease,  it  is  not 
hereditary.  They  admit  that  the  tendency  to  pulmonary 
consumption  may  be  transmissible  in  the  physical  formation 
or  mental  temperament  of  the  offspring,  but  that  the  disease  ' 
itself  is  not  handed  down  from  parent  to  child*  and  does  not 
claim  its  victims  at  birth.  The  celebrated  Dr.  Walsh e  says, 
after  a  careful  investigation  of  the  family  history  of  four 
hundred  and  forty-six  (446)  patients  with  this  malady,  that 
“  phthisis  in  the  adult  hospital  population  of  Great  Britain 
is  to  a  slight  amount  only,  a  disease  demonstrably  derived 
from  parents.” 

Not  to  pursue  any  further  the  reasoning  of  the  advocates 
of  this  plausible  and  more  pleasing  theory  of  the  origin, 
nature,  and  curability  of  this  destructive  disease,  should  we 
not  feel  encouraged  to  have  more  faith,  and  to  use  more 
perseverance,  in  the  prophylatic  measures  so  naturally  sug¬ 
gested  by  the  theory  presented?  As  is  a  man’s  faith  so  will 
lie  be,  as  he  thinks  and  resolves  so  will  lie  put  forth  his 
efforts  and  continue  in  his  hopes  and  energies. 

There  is  encouragement,  I  repeat,  in  these  cases  of  pulmo¬ 
nary  consumption.  The  great,  golden  rule  is  to  sustain  and 
bring  up  the  general  strength.  The  entire  'physical  system 
shotdd  be  raised  to  the  highest  possible  vigor.  In  the  young 
physical  culture  is  the  safeguard  against  consumption.  Incipient 
phthisis  is  always  preceded  by  debility.  This  debility 
engenders  like  feebleness  of  respiration,  and  this  accom¬ 
panies  or  rather  produces  insufficient  pulmonary  excretion 
with  its  consequent  accumulation  of  this  epithelial  debris. 
The  forerunner  of  debility  may  arise  from  inadequate  nutri¬ 
tion  or  deficient  food,  protracted  sickness,  overburdening 
mental  cares  and  anxieties.  I  have  often  thought  that  this 
alarming  increase  of  consumption  here,  especially  since  the 
war,  was  in  all  jmobability  owing  mainly  to  the  general 
and  well  known  prevalence,  since  then  among  us,  of  these 
very  causes.  The  deficient  clothing  and  food  and  general 
suffering,  as  I  before  said,  of  our  colored  population,  doubt¬ 
less  bears  an  important  part  in  the  production  of  a  greatly 
increased  mortality  from  consumption  among  that  race  in 
the  Southern  States. 


27 


Drive  off  this  actual  or  threatened  accumulation  of  tubercular 
deposit  by  all  those  means  which  will  add  to  the  flesh  and  general 
strength. ,  and  by.  all  those  measures  which  loill  give  the  greatest 
vigor  to  the  respiratory  act  and  add  to  the  fullest  expansion  of 
the  entire  lungs .  Special  and  methodical  attention  to  full 
respiratory  action  and  to  a  development  of  the  respiratory 
muscles — active  muscular  exercise  in  the  open  air — a  free 
use  at  all  times  of  fresh  air — a  diet  nutritious  and  digestible 
— suitable  protection  to  the  skin — united  to  a  habitual  exer¬ 
cise  of  hope  and  cheerfulness,  will  not  alone  insure  general 
health  to  the  lungs  and  body,  but  will,  in  a  large  majority  of 
cases,  prevent  the  formation  and  secure  the  removal  of  those 
pulmonary  deposits,  upon  which  the  ravages  of  consumption 
are  based.  Why  do  children  enjoy  such  a  happy  immunity 
from  its  attacks  ?  Because  the  activity  of  their  habits,  the 
energy  of  their  respiratory  movements,  and  their  love,  when 
well,  of  the  open  air,  which  gives  them  a  plenty  of  oxygen 
and  a  full  expansion  of  their  lungs,  are  safeguards  to  the 
accumulation  of  tubercular  material.  The  waste  and  repair 
of  tissue  in  children  is  very  rapid,  and  were  it  not  for  the 
energy  and  efficiency  of  their  habits  and  love  of  play  and 
exercise,  they  would  not  be  blessed  with  this  fortunate 
exemption.  But  when  they  arrive  at  the  age  of  puberty 
their  pleasures  and  habits  change.  The  boy  is  confined  at 
home  or  at  school,  and  hours  which  should  be  given  to  play 
or  the  exercise  of  his  lungs,  finds  him  at  his  books  or  at  some 
other  close  occupation  that  denies  exercise  to  his  body  and 
expansion  to  his  lungs.  It  is  the  same  with  the  girl.  She 
no  longer  romps  over  the  fields,  or  sings  gladsome  songs  as 
she  glides  rapidly  along  wherever  she  pleases.  But  she  is 
placed  under  the  restrictions  of  fashion  and  under  the  dis¬ 
cipline  of  home  and  school,  which  regards,  too  little  the 
claims  of  health  and  good  lungs.  She  is  imprisoned .  in 
tight  dresses,  her  neck  and  arms  perhaps  bare,  and  is  denied 
the  merry  laugh,  the  running  gait,  and  other  exercises  so 
much  needed  to  give  form  and  grace  to  her  body  and  expan¬ 
sion  to  her  lungs.  Can  we  wonder  soon  to  see  that  prom¬ 
ising  boy  and  that  charming  girl  yielding  to  those  seeds  of 
consumption  engendered  by  the  unnatural  and  cruel  ch  ango 
to  which  unwise  regulations  of  home  and  unphilosophical 
rules  of  school  subject  so  generally .  the  youth  of  our 
country  ?  The  wild  beast,  confined  within  liis  iron  bais, 
often  dies  with  consumption,  while  the  parents  continue  to 
roam  their  native  forests  to  an  extreme  old  age,  and  die  nom 
some  other  cause. 

The  remarkable  benefit  derived  by  our  consumptive 
T) 


soldiers  during  the  late  war,  from  the  fresh  air  and  rough 
living  of  army  life  can  never  be  forgotten  while  memory 
reverts  to  those  trying  days,  or  history  shall  transmit  their 
unequalled  heroism  to  future  ages.  They  left  home,  hosts  of 
them  with  feeble  lungs,  often  bearing  incipient  tubercles. 
Others,  actually  were  wasting  away  with  night  sweats  and 
profuse  expectoration,  and  were,  on  this  account,  never 
expected  to  return.  A  decided  improvement  seems  to  have 
been  the  result  in  nearly  every  instance,  and  complete 
recovery  followed  most  of  those  unpromising  cases.  Those 
who,  with  weak  lungs  and  newly  formed  tubercular  deposit 
were  able  to  escape  other  casualties  of  war,  returned  home, 
as  I  before  said,  always  greatly  improved  and  generally 
restored.  If  such  examples  and  facts  do  not  bear  their 
valuable  lessons  of  wisdom  and  of  warning  to  us  all,  then 
may  we  turn  a  deaf  ear  to  the  teachings  of  experience  or  the 
deductions  of  observation.  It  is  good  fresh  air,  then,  and  not 
confinement  in  ceiled  houses  with  closed  doors  that  our 
people  should  value,  especially  those  who  dread,  or  have, 
consumption.  Muscular  exercise,  free  and  persistent,  with 
that  all-important  attention  to  the  functions  of  nutrition — to 
digestion  and  assimilation,  will  save  our  patients  from  con¬ 
sumptive  graves,  if,  with  living  faith  in  the  means  suggested, 
we  can  in  time  have  the  entire  management. 

To  provide  for  the  physical  education  of  the  children 
around  us,  is  as  much  a  duty,  sadly  though  it  is  neglected, 
as  is  the  education  of  their  morals  and  minds.  He  whose 
children  and  wards  are  liable  to  this  fell-destroyer  of  so 
many  of  the  human  race,  should  especially  bear  in  his  bosom 
at  all  times  an  enduring  consciousness  of  the  duty  which 
this  solemn  truth  suggests.  As  conservators  of  the  public 
health,  let  us  on  all  appropriate  occasions,  impress  upon 
every  parent,  guardian,  and  instructor  of  youth,  the  vital 
importance  of  protecting  children  with  warm  clothing — of 
securing  for  them  an  abundance  of  frc  sh  air  and  sun-light ; 
that  all  their  rooms  and  apartments  be  well  ventilated  ;  that 
bathing  be  made  a  family  arrangement ;  that  the  diet  be 
plain  and  nutritious  ;  that  proper  habits  of  self-control  in 
eating  be  acquired,  and  that  exercise  sufficient  to  develop 
all  the  muscles  be  regularly  observed.  Due  attention  to 
these  things  is  not  alone  necessary  to  the  health,  comfort 
and  usefulness  of  the  child,  but  essential  to  the  happiness  of 
parents  and  to  the  general  good  and  prosperity  hereafter  of 
the  whole  State  and  country. 


29 


GENERAL  TREATMENT  OF  FEVERS  AND  ACUTE  INTERNAL  INFLAMMA¬ 
TIONS. 

He  13  the  wise  physician  who,  bringing  to  his  daily  prac¬ 
tice  a.  mind  untrammelled  by  prejudice  or  preconceived 
ideas  of  earlier  training,  follows  the  teachings  of  observa¬ 
tions  and.  the  legitimate  deductions  of  science.  Such  a 
practitioner,  while  informing  himself  of  the  views  of  others 
and  the  doctrines  of  his  profession  at  different  epochs,  will 
at  the  same  time  carefully  observe  for  himself.  Thus  armed 
he  will  go  forth  to  battle  with  disease  in  that  spirit  of  inde¬ 
pendence  and  self-reliance  which  forms  a  material  attribute 
of  every  truly  successful  physician.  He  treats  Iris  patients 
upon  general  principles,  modified  not  only  by  the  sugges¬ 
tions  of  each  particular  case,  but  by  the  surrounding 
circumstances  and  prevailing  tendencies  and  indications. 
Profiting  by  the  observations  of  every  case,  and  the  expe¬ 
rience  of  the  changing  seasons  and  years,  he  heeds  on  the 
one  hand  neither  the  extreme  views  of  blind  devotees  of  the 
past,  nor  on  the  other  the  assumptions  of  the  ultra  advocates 
of  the  innovations  and  reforms  of  the  present.  But 
gathering  as  a  philosopher  from  the  past,  as  well  as  the 
present,  avoiding  those  Sc3dlas  and  Charybdes  of  his  pro¬ 
fession  that  have  always  existed,  he  becomes,  in  truth,  the 
genuine  eclectic  in  its  true  sense,  learned  and  unprejudiced 
while  conservative  and  successful.  Pursuing  such  a  course 
of  common  sense  and  enlightened  experience,  he  cannot 
fail  to  consult  as  guides  the  great  Books  of  Nature  and  the 
Laws  of  Disease.  This  accustoms  him  to  follow  the  methods 
suggested  by  the  changing  forms  and  types  of  diseases  of 
the  different  seasons  and  years,  modified  by  the  locality, 
climate  and  varying  indications  of  each  individual  case. 
From  such  stand  points  arises  the  general  treatment  of 
every  physician,  who,  leaving  routine  and  pre-existent 
partialities  and  prejudices  to  such  inferior  minds  as  will  not 
study  and  think,  is  governed  by  his  own  knowledge,  and 
observation  as  connected  with  the  broad  and  established 
principles  of  his  profession.  Such  a  course  may  not  win  for 
him  the  admiration  of  shallow  minds  or  the  sensational 
applause  of  the  fickle  multitude  so  prone  to  be  captivated 
by  attractive  novelties  and  the  bold  innovations  of  extremists. 
But  instead  thereof  he  will  avoid  the  injury  which  such  nu  n 
do  to  science  and  humanity.  Ho  will,  in  addition,  justg 
secure  the  more  enviable  reputation  of  skill  and  success  m 
practice.  He  will  gather  around  him  the  sincere  friendsnip 
and  lasting  esteem  of  the  learned,  the  sensible,  and  me 


30 


appreciative.  When  ultraists  and  extremists  have  gone 
down  in  ridicule,  or  are  forgotten  in  their  graves,  his  memory 
will  be  fondly  cherished,  and  remain  to  illumine  the  pages  of 
Medical  History. 

In  this  section  of  the  State,  we  treat  disease  according  to 
indications.  In  one  or  more  seasons  the  asthenic  type  is  so 
prevalent,  the  tendency  so  strong  to  the  typhoid  form,  that 
in  acute  inflammations  and  fevers  we  apply  the  antiphlo¬ 
gistic  treatment  with  much  caution.  In  such  years  we 
seldom  use  the  lancet,  except  in  occasional  instances  of 
violent  inflammation  and  severe  congestive  fevers.  At  other 
periods  we  find  the  disease  more  sthenic  in  character — the 
inflammatory  symptoms  of  a  higher  range — cases  more 
violent  and  hurry  more  rapidly  either  to  resolution,  if 
properly  aided,  or  to  a  fatal  end  if  neglected  or  improperly 
treated.  Under  such  indications  it  becomes  our  duty  to 
apply  with  a  bolder  hand  the  antiphlogistic  treatment — 
sometimes  using  the  lancet,  more  generally  those  mercurial 
purgatives,  blisters,  local  depletion,  diaphoretics,  and  de¬ 
pressants  which  in  this  locality  cannot  be  dispensed  with 
when  our  ordinary  congestions  and  acute  inflammations 
assume '  an  aggravated  character.  So  that  our  treatment 
depends  upon  the  prevailing  type  and  individual  indications. 
This  is  the  result  of  my  observation  and  experience,  based 
upon  a  laborious  practice  for  the  last  twenty  years  in 
Eastern  North  Carolina.  Earlier  in  my  medical  life  the 
sthenic  tide  was  up  and  my  lancet  was  often  used.  For  a 
number  of  years  past  it  has  become  somewhat  rusty,  because 
the  asthenic  waves  have  prevailed,  though  it  remains  in  my 
pocket  case  as  a  necessary  companion.  Well  do  I  remember, 
as  my  note  book  shows,  the  high  grade  of  many  of  my  cases 
treated  in  earlier  life,  and  I  used  the  lancet  freely  and  often 
and  with  marked  benefit.  It  was  indispensable  that  I  should 
open  the  batteries  of  my  antiphlogistic  treatment  in  order  to 
save  human  life.  But  in  more  recent  years  the  indications 
are  changed — the  type  is  lower,  and  I  bleed  more  rarely 
and  deplete  less  freely.  I  am  aware  that  Markham,  Watson 
and  other  distinguished  medical  men  maintain  the  contrary 
theory,  but  the  great  majority  of  the  master  minds  of  the 
profession  are  united  with  the  great  masses  of  active  prac¬ 
titioners  in  support  of  the  belief  that  diseases  change  in 
their  type.  If  we  could  discard  the  word  type  and  regard 
the  discussion  as  betwmen  sthenic  and  asthenic  forms  and 
dispositions  much  embarrassment  would  be  prevented  and 
extraneous  matter  avoided.  But  we  must  take  the  question 
as  it  stands :  that  nature  is  powerful  and  often  efficient  to 


31 


throw  off  disease  ‘no  one  will  deny  ;  that  the  expectant 
system  will  sometimes  answer,  cannot  be  disj3uted.  No1 
judicious  practitioner  ever  fails  to  call  to  his  aid  all  the 
conservative  strength  that  is  possible  from  this  source. 
Perhaps  the  truth  more  generally  lies  between  the  extreme 
advocates  of  the  phlogistic  and  antiphlogistic  systems. 
Each  correct  under  certain  circumstances,  both  in  error' 
under  other  conditions.  Especially  do  they  seem  to  be 
wrong  in  the  uncompromising  tenacity  with  which  they  hold 
to  their  peculiar  views,  unmodified  by  circumstances.  How¬ 
ever  this  may  be,  let  us,  I  repeat,  maintain  ourselves  free 
from  prejudice  and  passion  in  the  contests  of  those  rival 
theories  that  have  so  long  divided  the  medical  world,  and 
with  the  single  aim  of  medical  truth  follow  observation  and 
the  legitimate  deductions  of  medical  logic  whithersoever 
they  may  lead. 

These  sentiments  do  not  create  any  sympathy  in  me  for 
that  wholesale  proscription  and  sweejung  denunciation  of 
the  antiphlogistic  system  so  generally  indulged  in  by  the 
followers  of  Todd,  Bennett  &  Company.  It  has  become 
too  fashionable  to  denounce  as  old  fogies  and  as  enemies  to 
true  medical  progress  those  who  refuse  to  join  the  ranks  of 
these  proscriptive  men.  Our  medical  students,  who  go.  to 
more  northern  medical  colleges  every  year  for  instruction, 
are  taught  by  professors  who  never  saw  a  case  of  malarial 
fever  or  treated  a  case  of  our  high  grades  of  internal  inflam¬ 
mation,  that  it  is  suicidal  to  bleed  and  ignorance .  to  give 
calomel,  and  they  are  taught  to  regard  as  behind  this 
enlightened  age  those  Southern  practitioners  who  presume 
now  to  use  in  any  case  these  antiphlogistics.  I  conceive  it 
a  duty,  therefore,  to  speak  out  on  this  subject  noiv ,.  as  these 
onslaughts  upon  truth  and  the  practice  and  writings  of  a 
very  large  majority  of  the  great,  leading  medical  minds  of 
all  ages  and  countries,  are  not  conducive  to  the  interests,  of 
medical  science  or  to  humanity,  so  long  as  their  heresies 
remain  unanswered  and  are  not  exposed.  I  am  the  more 
disposed  to  discuss  this  question,  because  of  the  industrious 
efforts  being  made,  within  a  recent  period,  to  spread  in  our 
own  State  these  dangerous  doctrines  of  Todd,  Bennet  &  Co. 
Their  followers  are  earnestly  soliciting  their  acceptance,  by 
the  profession  of  our  good  old  State,  so  uniformly  unwilling 
of  her  own  choice  to  accept  heresies  of  any  kind,  whether 
medical,  -political  or  religious.  One .  of  our  own  sons,  a 
gentleman  of  talent  and  promise  in  his  profession,  ^  a 
prominent  member  of  this  Society,  bearing  an  honore 
name,  which,  by  its  high  accomplishments  and  brig  it  pro- 


Sessional  lustre,  lias  illumined  the  medical  annals  of  the 
State,  has  fallen  from  grace,  and  now  stands  forth  among  us 
as  the  representative  man  in  North  Carolina  of  this  mis- 
cliievous  doctrine.  I  need  scarcely  say  that  I  allude  to 
William  A.  B.  Norcom,  M.  D.,  of  Edenton,  whose  Annual 
Address  before  this  Body  at  Warrenton,  in  May,  1868,  has 
atttracted  much  attention,  and  deserves  to  be  noticed,  in  our 
general  allusions,  to  the  sentiments  of  those  whom  he  quotes 
and  endorses.  However  ungracious  the  task,  it  is  clue  to 
science  and  the  profession  that  such  sophistry  should  be 
exposed,  and  such  false  premises  and  illogical  deductions 
overthrown.  Dr.  Norcom’s  address  is  ingenious  and  well 
put  together,  but  untenable  and  injurious  upon  medical 
practice.  It  is  the  more  surprising  and  to  be  regretted  that 
he  has  fallen  into  these  errors,  because  his  whole  life  has 
been  passed  amid  disease  that  has  presented  indications  I 
respectfully  submit,  calling  for  different  treatment  than  that 
he  now  advocates.  Unlike  those  noted  authors  whom,  he 
quotes,  scarcely  one  of  whom  knows  anything  practically  of 
of  the  nature,  grade,  and  demands  for  treatment,  of  our 
Southern  acute  diseases,  he  is  one  of  our  own  physicians, 
daily  in  contact,  from  his  location,  with  malarious  fevers  anct 
acute  internal  inflammations,  demanding,  as  I  insist,  a  more 
rational  treatment  than  he  applies. 

The  opponents  of  blood-letting  and  mercury  assume,  as 
their  premises,  that  the  progress  of  medical  science  and  the 
revelations  of  truth  have  subverted  the  antiphlogistic 
system,  and,  in  place  thereof,  have  substituted  alimentation, 
stimulants  and  similar  remedies.  That  blood-letting,  mer¬ 
curial  purgatives  and  other  depletants  and  lowering  remedies 
are  injudicious  and  uncalled  for,  and  that  they  prolong, 
rather  than  shorten  disease — increase,  rather  than  decrease 
mortality.  Bespectable  medical  authorities,  not  novel  to 
the  profession,  are  quoted  in  support  of  these  statements. 
Some  of  the  very  authorities,  quoted  in  support  of  the  posi¬ 
tion  taken,  may  be  arrayed  in  opposition  thereto  in  other 
portions  of  their  writings.  When  Dr.  Norcom  mentions  one 
prominent  author,  in  vindication  of  his  views,  he  might  have 
named  dozens  equally  high  in  authority  against  himself. 
He  fails  to  acknowledge  that  the  grade  of  fevers  and  inflam¬ 
mations  of  this  latitude  generally  produce  such  disturbances 
and  indications,  as  to  demand  a  more  vigorous  treatment 
than  do  the  acute  diseases  of  the  regions  embraced  in  the 
fields  of  practice  of  his  learned  supporters  in  Europe  and 
elsewhere,  who  wage  this  war  against  the  lancet.  There  tlie 
observations  of  those  authors  are  based  in  the  main  upon 


Hospital  and  Dispensary  practice,  when  most  of  the  cases 
treated  have  passed  from  the  acute  to  the  chronic  stage 
before  admission,  and,  of  course,  rendering  blood-letting 
inadmissible.  Most  of  their  cases  are  asthenic  in  character 
and  different  from  the  acute  diseases  of  our  latitude  that  are 
more  phlogistic  and  demand  a  more  active  treatment. 
<£  Distance,”  too,  “  lends  enchantment  to  the  view,”  and  names 
arrayed  here  as  distinguished  lights  in  the  profession  and  as 
offered  to  all  lowering  treatment,  wTill  be  found  by  Dr.  Nor- 
com  to  be  more  transcendental  extremists,  patronized  but 
little  at  home  and  more  respected  abroad.  They  will  suffer 
in  comparison  with  the  scores  of  those  successful  and 
illustrious  men  in  all  ages,  who  maintain  adverse  views,  who 
were  sensible  and  practical,  and  who  contribute  to  adorn  the 
brighest  pages  of  Medical  History. 

Dr.  Norcom  sets  out  with  the  emphatic  declaration  that 
“  great  progress  and  improvement  have  taken  place  in  our 
profession,”  and  says  that  “  nowhere  is  this  more  apparent 
than  in  the  treatment  of  Acute  Internal  Inflammations.” 
The  improvement  on  this  point  is  questionable.  There  is  no 
fact  to  prove  that  the  treatment  of  acute  internal  inflamma¬ 
tions  has  improved.  For  thousands  of  years  the  anti¬ 
phlogistic  treatment  was  employed  successfully  by  the 
greatest  physicians — the  founders  of  the  science  of  medicine, 
to  whom  it  owes  everything,  commencing  with  Hippocrates 
and  running  down  its  illumined  pages  to  Watson,  Aitkin, 
Wood,  and  others  of  the  present  day.  The  efficacy  of  tlio 
anti-phlogistic  plan  has  been  attested  by  the  experience  and 
observations  made  upon  millions  and  myriads  of  cases^ 
Until  the  new  lights  can  show  better  and  more  numerous 
authorities  for  the  superiority  of  their  so-called  novelties 
(but  really  not)  the  improvement  is  not  established. 

He  next  says :  ££  Foremost  in  importance  stands  the 

enforcement  of  the  study  of  their  Natural  History  and  a 
revival  of  the  Hippocratian  doctrine  of  a  greater  reliance 
upon  nature  rather  than  of  a  perturbatory  and  lowering 
treatment  and  the  substitution  of  a  proper  and  sufficient 
alimentation  for  low  diet — yes  we  may  say  starvation. 

The  promulgation  of  this  statement  is  founded  upon  a 
total  misconception  or  misapprehension  of  the  doctrines 
and  practices  of  Hippocrates.  So  far  from  being  offered  to 
lowering  or  anti-phlogistic  treatment,  he.  was  one  of  its 
most  constant  and  enthusiastic  supporters,  in  fact  one  of  its 
very  founders.  It  is  true  he  employed  it  judiciously  and 
wisely,  but  on  all  proper  occasions,  especially  in  the  treat¬ 
ment  of  acute  internal  inflammations,  he  was  one  oi  tiro 


34 


boldest  practitioners  the  world  has  ever  known.  This  is 
proven  by  the  following  quotations  from  his  works,  within 
the  reach  of  every  physician.  I  quote  from  the  translation 
of  Dr.  Francis  Adams,  published  by  the  Sydenham  Society 
of  England,  London  1849  : 

“  1st.  Bleed  in  the  acute  affections,  if  the  disease  appears 
strong  and  the  patients  be  in  the  vigor  of  life,  and  if  they 
have  strength. 

“  2.  Again  :  Hypochondria  not  from  retention  of  flatus, 
tension  of  the  diaphragm,  checked  perspiration,  with  dry 
orthopnoea,  when  no  pus  is  formed,  but  when  these  com¬ 
plaints  are  connected  with  obstructed  respiration,  more 
especially  strong  pains  above  the  diaphragm — diseases  con¬ 
nected  with  a  collection  of  humours— all  these  diseases  do 
not  admit  of  resolution  if  treated  first  by  medicine,  but 
venesection  holds  the  first  place  in  conducting  the  treatment. 

“  3.  Again  :  When  a  person  suddenly  loses  his  speech,  in 
connection  with  obstruction  of  the  veins,  if  this  happen 
without  warning  or  any  other  strong  cause,  we  ought  to  open 
the  internal  vein  of  the  right  arm  and  abstract  blood,  more 
or  less,  according  to  the  habit  and  age  of  the  patient. 

“4.  Again:  Patients  seized  with  Epilepsy  or  Apoplexy 
are  immediately  to  be  bled  at  the  commencement. 

“  5.  Again :  In  peri-pneumona  and  pleuritic  affections, 
bleed  largely  and  boldly,  if  the  pain  be  acute,  so  as  to  bring 
on  delinqum  animi. 

“  6.  Again  :  When  Pneumonia  is  at  its  height  the  case  is 
beyond  remedy,  if  he  is  not  purged.  In  Quinsy,  bleed  in  the 
arm  and  open  the  sublingual  veins. 

“  7.  Again :  In  Dropsy,  if  he  labors  under  difficultly  of 
breathing,  if  it  is  in  the  summer  season,  and  if  he  is  in  the 
prime  of  life,  blood  should  be  abstracted  from  the  arm. 

“  8.  Again  :  The  most  important  point  of  regimen  to 
observe  and  be  guarded  about  in  protracted  diseases,  is  to 
pay  attention  to  the  exacerbations  and  remissions  of  fever, 
so  as  to  avoid  the  times  when  food  should  not  be  given,  and 
to  know  when  it  may  be  administered  without  danger.  This 
last  season  is  at  the  greatest  possible  distance  from  the 
exacerbation. 

“  9.  Again :  If  you  think  expedient  to  let  blood,  see  that 
the  bowels  be  previously  settled,  and  then  bleed.  Conjoin 
abstinence,  and  forbid  the  use  of  wine,  and  complete  the 
cure  by  means  of  a  suitable  regimen  and  wet  fomentations. 

“  10.  Again :  For  extreme  diseases,  extreme  methods  of 
cure  as  to  restriction  are  most  suitable.  When  the  disease 
is  very  acute,  it  is  attended  with  extremely  severe  symptoms* 


35 


in  its  first  stage,  and,  therefore,  an  extremely  attenuating 
diet,  must  be  used.  When  this  is  not  the  case,  but  it  is 
allowable  to  give  them  more  generous  diet,  we  may  depart  in 
so  far  from  the  severity  of  regimen  as  the  disease  by  its 
mildness  is  removed  from  the  extreme.  When  the  disease 
is  at  its  height,  it  will  then  be  necessary  to  use  a  more 
slender  diet.  We  must  retrench  during  paroxysms,  for  to 
exhibit  food,  would  be  injurious.  And  in  all  diseases  having 
periodical  paroxysm  w*e  must  restrict  during  the  paroxysms/’ 

How  unjust  then  to  the  memory  of  this  immortal  Father 
of  Medicine,  the  very  author  of  blood-letting  and  rigid  diet, 
that  Dr.  Norcom  should  refer  to  him  in  support  of  the  theory 
of  a  greater  reliance  on  nature  rather  than  upon  a  perturba- 
tory,  and  lowering  treatment.  True,  Hippocrates  relied 
much,  as  all  sensible  men  do,  upon  the  powers  of  nature  in 
the  treatment  of  disease,  but  we  see  from  the  above  and 
similar  quotations  that  might  be  given  from  him,  that,  when 
treating  severe  inflammations  and  high  fevers,  he  used 
additional  means  as  do  judicious  practitioners  at  this  en¬ 
lightened  day.  From  these  passages  it  will  be  clearly  seen 
that  Hippocrates  was  one  of  the  prime  originators  of  the 
lowering  treatment,  bleeding  his  patients  freely  and  as  largely 
as  they  would  bear,  and  following  it  by  rigid  diet.  He  even 
forbade  the  use  of  barley  water  until  the  inflammation  was 
arrested.  Flow  little  support  do  shell  or  any  of  the  writings 
of  Hippocrates  give  to  the  plan  pursued  by  Todd,  who  saysy 
“  there  is  no  necessity  for  having  recourse  to  violent  anti- 
*  phlogistic  measures  in  cases  of  pneumonia  [Clinical  Lectures 
Phil.,  Ed.  page  271]  and  who  in  “  rapidly  spreading 
pneumonia”  gave  “half  an  ounce  of  brandy  every  hour,” 
[page  266  ibid]  and  in  another  case  of  laryngitis,  with 
pneumonia  and  delirium,  gave  half  an  ounce  of  brandy  every 
half  hour.  It  is  true  the  patients  recovered,  but  have  they 
not  recovered  after  the  worst  treatment  ever  invented  ?  How 
different  the  treatment  of  Hippocrates  and  that  of  Dr.  Nor- 
com,  who,  to  a  child  eight  years  old,  with  a  severe  pneu¬ 
monia,  with  pulse  140  and  respiration  70  to  the  minute,  gave 
three  pints  of  milk,  one  and  a  half  pints  of  rich  soup,  with 
little  alcoholic  stimulus  every  twenty-four  hours !  Dr. 
Fiore om’s  treatment  is  neither  that  of  Hippocrates  or  Todd. 

Leaving  Hippocrates,  we  find  that  all  the  greater  classics 
of  antiquity  advocated  judicious  anti-phlogistic  treatment  in 
acute  internal  inflammations.  Celsus  recommended  both 
venesection  and  cupping — [Edinburg  Ed.  1814,  pp.  60-64.] 
in  pestilential  and  ardent  fevers,  ho  says,  “  if  the  strength 
will  admit  it  is  best  to  let  blood.”  [Page  103.]  In  the  case 

E 


of  a  semi-tertian  ne  says  :  •*  unless  mere  is  some  important 
reason  against  it,  blood  ought  to  be  let  in  the  beginnig.”  In 
pleurisy  he  says:  “Now  the  cure  of  a  violent  and  recent  pain 
is  letting  of  blood.”  [Page  161.] — of  pneumonia  and  its 
cure  he  says  :  “  It  is  fit  if  the  strength  will  admit  of  it  to  let 
blood.”  Of  the  disease  of  the  liver  and  its  cure  he  says, 
[page  1641]  “  in  the  beginning  the  best  thing  is  to  let  blood, 
then  the  bowels  must  be  opened — if  this  cannot  be  done 
otherwise  by  means  of  black  hellebore.”  “In  ileus  the  cure 
is  letting  of  blood.” 

If  we  turn  to  the  pages  of  Galen  we  find  that  he  is  a . 
strenuous  advocate  of  anti-phlogistics  in  all  acute  internal 
inflammations.  Thus  in  his  books  on  Therapentics,  ad¬ 
dressed  to  Glaucus,  he  says :  “  We  will  say  then  that  it  is 
necessary  to  consider  the  age  of  the  patient,  the  season,  the 
country,  the  actual  condition  of  the  air,  the  strength  of  the 
patient,  his  complexion,  his  habits,  and  even  the  state  of  the 
disease.  In  fact  you  will  ascertain  from  these  whether  it  is 
necessary  to  evacuate  or  not,  and  when  and  how  it  ought  to 
be  done,  for  example  in  the  diathesis  in  question.  Thus  if 
the  determination  is  to  the  knee,  the  j'oint  suddenly  swelling 
greatly,  if  the  whole  body  is  redundant  with  blood,  the 
patient  vigorous,  the  disease  occurring  in  the  spring  in  a 
very  temperate  climate,  $nd  the  subject  a  youth  or  young 
man,  it  will  require  an  evacuation  of  blood  from  the  upper 
parts,  and  to  select  from  the  veins  of  the  fore  arm — the 
internal  or  median  vein.  If  one  of  the  superior  parts  aro 
affected  the  blood  must  be  drawn  from  the  inferior  region.” 
[Vol.  11,  pp.  746-50.]  Also  in  inflammation  of  the  uterus, 
ovaries,  spleen,  liver,  angina,  affections  of  the  head,  &c., 
bleeding  is  enjoined  and  the  mode  in  which  it  is  to  be  em¬ 
ployed  and  the  locality  of  the  operation  minutely  described — 
[vol.  2,  pp.  755-6.] 

If  we  consult  Aretaeus  we  find  him  endorsing  the  treatment 
advocated  by  Hippocrates  and  Galen.  He  recommends 
bleeding  in  apoplexy  [page  259]  and  cupping  [page  265]  in 
tetanus  moderately,  abundantly  in  Cynanche  with  light  diet, 
[page  270.]  In  pleurisy  repeated  bleedings  [page  286]  and 
cupping  [291]  are  recommended.  Repeated  bleedings  in 
pneumonia  [page  296]  in  persons  of  plethoric  habits,  in  ileus, 
in  acute  affections  of  the  liver  [page  335]  and  in  fact  in  all 
acute  diseases  attended  with  fever  and  inflammation. 

The  observations  of  Paulus  iEgineta,  [Syd.  Soc.  Ed. 
1844,  London,]  one  of  the  most  celebrated  writers  after 
Galen,  proves  that  blood-letting  was  the  universal  practice 
among  the  leading  authorities  of  his  and  previous  times. 


37 


At  tlio  same  time  lie  employed  it  judiciously  just  like  all 
men  of  good  sense  use  everything — cautiously  when  doubtful 
and  withholding  it  when  injurious.  Paul  of  Egina  says  that 
“  if  the  peripneumonia  was  the  original  affection  and  the 
strength  admit  we  must  open  a  vein,  or  if  not  we  may  cup, 
proportioning  the  evacuation  of  blood  to  the  powers  of  the 
patient,  but  if  the  disease  originate  from  the  conversion  of 
other  diseases  into  this  (secondary  pneumonia)  we  must  not 
have  recourse  to  venesection,  more  especially  if  the  disease 
be  of  a  chronic  nature ,  and  if  blood  had  been  previously 
drawn.”  What  admirable  rules !  In  all  ages  we  see  that 
those  who  employed  bleeding  boldly,  yet  in  many  cases 
withheld  it  altogether.  Indeed  many  things  now  promul¬ 
gated  as  new  more  properly  belong  to  the  men  and  ages  of 
the  past.  Among  the  Arabians  who  treated  pneumonia  like 
the  Greeks,  and  which  Haley  Abbas  describes  as  a  hot 
inflammation  of  the  lungs,  for  which  he  recommended 
bleeding,  cooling  and  diluent  drinks,  &c.  We  still  find 
Bhazes  describing  a  species  of  pneumonia  which  was  treated 
with  tonics,  wine,  &c.  [Commentary  Paulus  Eginefa 
vol.  1 — 482.] 

If  we  come  down  to  Sydenham  we  find  that  in  acute 
internal  inflammations — pleurisy  for  example — “  the  fever 
and  its  most  dangerous  symptoms  were  best  relieved  by 
bleeding  in  the  arm,  applying  blisters  to  the  neck  and  giving 
injections  every  day.”  Change  in  the  character  of  disease 
was  even  then  sometimes  observed.  He  says  :  “  Now  though 
I  conceive  that  a  true  and  essential  pleurisy,  which,  as  shall 
hereafter  be  observed,  happens  indifferently  in  all  constitu¬ 
tions,  does  in  all  years  equally  indicate  repeated  bleeding ; 
yet  it  sometimes  happens  that  the  peculiar  epidemic  fever  of 
the  year,  from  some  sudden  alteration  of  the  manifest 
qualities  of  the  air,  readily  throws  off  the  morbific  matter 
upon  the  lungs  and  pleurae,  whilst  the  fever,  notwithstanding, 
continues  exactly  the  same.  Wherefore,  in  this  case,  though 
bleeding  may  be  used  to  abate  the  symptom  when  it  is  very 
violent,  yet,  generally  speaking,  little  more  blood  ought  to 
bo  taken  away  than  is  required  by  the  fever  whenever  this 
symptom  depends.” — [Sydenham’s  Works,  London,  1768, 
vol.  1 — 339.] 

The  great  Cullen,  whose  authority  was  for  a  long  time 
cognized  throughout  the  whole  medical  world,  was,  a 


reco 


IS  is 


_ throughout — - — ----- 

well  known,  an  advocate  of  the  antiphlogistic  treatment,  m 
acute  internal  inflammations  and  fevers.  He  says  :  “  Nothing 
is  more  evident  than  that  blood-letting  is  one  oi  the  mosu 
powerful  means  of  diminishing  the  activity  of  the  whole  oouy, 


;38 

especially  of  tlie  sanguineous  system,  and  it  must,  therefore, 
be  the  most  effectual  means  of  moderating  the  violence  of 
reaction  in  fevers.  Taking  this  as  a  fact,  I  omit  enquiring 
into  its  mode  of  operation,  and  shall  only  consider  in  what 
circumstances  of  fever  it  may  be  most  properly  employed. 
When  the  violence  of  reaction  and  its  constant  attendant,  a 
phlogistic  diathesis,  are  sufficiently  manifest,  when  these 
constitute  the  principal  part  of  the  disease  and  may  be 
expected  to  continue  throughout  the  whole  of  it,  as  in  the 
case  of  synocha,  then  blood-letting  is  the  principal  remedy 
and  may  be  even  played  as  far  as  the  symptoms  of  the 
disease  may  seem  to  require  and  the  constitution  of  tho 
patient  will  bear.  It  is,  however,  to  be  attended  to,  that  a 
greater  evacuation  than  is  necessary  may  occasion  a  slower 
recovery  ;  may  render  the  person  more  liable  to  a  relapso 
or  may  bring  on  other  diseases.”  He  then  states  under 
what  circumstances  blood-letting  is  to  be  used  in  fevers  and 
inflammations,  and  they  are  as  follows  : 

“  1st.  The  nature  of  the  'prevailing  epidemic. 

“  2.  The  nature  of  the  remote  cause. 

“  3.  The  name  and  climate  in  which  the  disease  occurs. 

“  4.  The  degree  of  phlogistic  diathesis  present. 

“  5.  The  age,  vigor,  and  plethoric  state  of  the  patient. 

“  6.  The  former  diseases  and  habits  of  blood-letting  of  the 
patient. 

“  7.  The  appearance  of  the  blood  drawn  out. 

“  8.  The  effects  of  the  blood-letting  that  may  have  been 
already  practised.” — [Yol.  1,  pp.  58-59.] 

To  these  names  may  be  added  those  of  Booerhave,  Andral, 
Ohomel,  Lronnec,  Louis,  Grisolle,  McIntosh,  Yalleit, 
Gintral,  Stokes,  and  the  great  .French  medical  philosopher, 
Bouillaud,  whose  directions  to  bleed  freely  in  acute  diseases 
I  have  heard  from  his  own  eloquent  lips,  as  I  followed  him 
through  his  wards  in  the  celebrated  de  la  charite  hospital  at 
Paris.  In  fact  there  are  but  few  physicians  of  note  who 
cannot  be  quoted  as  authority  in  support  of  the  antiphlo¬ 
gistic  treatment  in  acute  internal  inflammation.  And  yet 
these  great  men  are  charged  with  being  guilty  of  a  reckless 
and  profligate  waste  of  human  blood.  They  lay  down  the 
rules  by  which  this  treatment  is  to  be  guided,  and  these  rules 
are  as  good  now  as  they  ever  were.  If  our  acute  internal 
inflammations  of  the  present  day  were  attended  by  a  hard, 
full  pulse,  headache,  delirium,  redness  of  face  and  ardent 
fever,  we  would  bleed  as  much  as  ever,  but  this  is  not 
usually  the  case.  The  grade  of  reaction  is  lower  ;  the  type 
usually  typhoid  or  asthenic,  and  we  have,  therefore,  adopted 


a  more  moderate  treatment,  just  precisely  as  they  advised , 
and  even  commanded.  By  no  means  would  we  underestimate 
the  importance  of  improvements  in  physiology  and  pathology 
in  the  diagnosis  and  treatment  of  disease,  but  the  employ¬ 
ment  of  remedies  is  to  be  guided  by  results ,  and  surely  wo 
arrogate  to  ourselves  undue  importance  in  assuming  that 
we  of  to-day  are  better  judges  of  results  than  the  long  list  of 
illustrious  names  before  us.  The  mass  of  the  profession 
indeed  began  to  employ  bleeding  with  more  caution  long 
before  the  great  lecturers  said  a  word  about  it.  Men  of 
practical  common  sense  in  the  backwoods,  remote  from  the 
centres  of  learning,  and  who  never  read  a  medical  book  or 
journal,  recognized  this  change  of  disease  and  demand  for  a 
change  of  treatment  just  as  soon  as  this  new  party,  so-called, 
of  Todd,  Bennett  &  Co.  Men  of  common  sense,  who  are 
not  (led  off  by  the  power  of  prejudice  or  the  charms  of 
novelty,  will  profit  by  the  lessons  which  these  facts  teach. 
Every  physician,  endowed  with  powers  of  common  observa¬ 
tion,  who  is  conversant  with  the  history  of  medicine,  has  a 
good  share  of  clinical  experience,  and  refuses  to  allow  his 
mind  to  be  confused  by  narrow  circumscribed  theories,  is 
aware  of  them  and  has  always  been  and  always  will  be  guided 
by  them.  Men  may  fulminate  against  mercury,  tartar 
emetic  and  blood-letting,  still  the  judicious  and  discrimina¬ 
ting  practitioner  will  ply  them  with  success  and  snatch  his 
patients  from  the  jaws  of  death,  at  the  same  time  that  he 
guards  against  their  improper  use  and  bad  effects.  He  will 
also  seek  constantly  for  such  efficient  aids  and  substitutes  as 
observation,  accident  or  experiment  are  constantly  offering 
to  his  notice.  He  will  learn  something  of  the  Natural 
History  of  Disease  from  Hahneman,  of  the  use  of  cold  water 
from  Priestnitz,  of  the  expectant  method  from  the  French, 
and  of  the  capacity  to  endure  alimentation  and  stimulants 
from  Todd  &  Company.  He  will  be  ready  to  learn,  but  will 
not  discard  good  remedies  until  others  are  proved  to  be 
better,  numerous,  repeated,  prolonged  trials  are  necessary 
before  he  gives  up  Rules  of  Art  established  for  centuries. 

Again,  says  Dr.  Norcom  :  “  Let  us  bear  in  mind  that  there 
are  no  foreign  forces  to  be  attacked,  nor  is  there  an  excess 
of  vitality  but  a  deficiency  of  the  powers  which  naturally 
reside  in  the  organism.  Indeed  it  may  be  that  the  cause  ot 
the  attack,  which  demands  an  aid,  is  an  already  deficient 
vitality.  I  am  every  day  more  and  more  convinced  that  a 
recognition  and  observance  of  these  important  facts  must 
form  the  basis  of  successful  practice.  Rather  than  being 
too  intent  upon  driving  out  the  enemy,  let  us  busy  oui- 


40 


selves,  as  Dr.  Bennett  says,  to  secure  tlie  safety  of  the 
fortress — let  us  try  to  bring  the  individual  up  to  his  physi¬ 
ological  status.  In  a  word,  let  us  help  him  to  restore  his 
natural  powers.  This  support  can  only  be  given  by  food. 
As  Dr.  Hewett  says,  nutrition  is  the  basis  of  the  treatment 
-of  disease  and  no  other  is  possible  for  a  rational  system  of 
medicine.” 

The  plain  English  of  this  paragraph,  and  the  gist 
of  the  whole  address,  is,  that  disease  arises  from 
inanition ,  is  always  asthenic  *in  type,  and  always  requires 
the  same  treatment — “  support” — which  can  only  be  given  by 
food.  This  is  not  only  erroneous,  but  downright  absurdity — 
not  only  unsupported  by  facts,  but  in  direct  antagonism  to 
facts,  and  the  daily  observations  of  every  correct  medical 
observer.  Let  U3  give  an  instance  :  A  man  in  the  vigor  of 
life,  after  having  partaken  of  a  full  dinner  and  washed  it 
down  with  brandy  and  wine,  falls  from  his  chair  in  a  fit  of 
apoplexy,  shall  we  give  him  more  food  to  cure  him  ?  Shall 
we  attempt  to  induce  him  to  eat  another  dinner  and  drink 
more  wine,  or  relieve  the  oppressed  brain  by  bleeding  and 
purgatives,  cold  applications  to  the  head,  &c.  ? 

A  young  man  of  full  habit,  (if  these  toddyists  will  admit  a 
man  can  possess  a  habit  too  full)  who  has  not  missed  a  full 
meal  for  years,  is  suddenly  seized  with  acute  asthenic 
pneumonia,  agonizing  pain  in  the  side,  full  bounding  pulse, 
intense  headache,  difficult  breathing,  with  a  sense  of  weight 
and  oppression  in  the  chest,  nausea  and  vomiting,  what 
must  we  do  ?  Give  brandy  and  food  ?  Can  he  digest  it 
even  if  he  can  retain  it  upon  his  stomach  ?  Can  any  sane 
man  say  that  nutrition  can  be  accomplished  in  the  condition 
of  that  man’s  system  ?  On  the  other  hand,  is  it  not  known 
as  positively  as  any  thing  in  medicine  can  be,  that  a  free 
bleeding  has  relieved  this  condition  of  things,  in  some 
instances,  as  if  by  magic,  more  slowly  but  surely  in  others  ? 
Are  not  cases  of  this  kind  cut  short  by  antiphlogistic  treat¬ 
ment  ?  Is  not  human  life  saved  by  such  means  ?  Let  the 
great  lights  of  medicine  answer.  Says  Andral .  [Cours  de 
Pathologie  Intern,  Tome  11,  p.  34 — Paris,  1848.] — “  For 
many  centuries  the  treament  of  pneumonia  has  been  nearly 
the  same,  and  it  may  be  and  has  only  varied  in  degree. 
Blood-letting  has  constituted  its  basis.  The  advantages 
which  it  here  produces  is  much  more  direct  than  in  other 
inflammations,  for  in  diminishing  the  quantity  of  blood 
traversing  the  lung  in  a  given  time,  it  diminishes  the  activity 
of  its  functions — a  result  which  must  assist  in  the  most 
efficacious  manner  in  the  cure  of  pneumonia,  ”  “  Venesec- 


41 


tion  is  the  method  to  which  we  ought  principally  to  have 
recourse.  This  especially  at  the  commencement  of  pneumonia, 
when  the  lung  is  only  engorged  that  a  copious  bleeding  often 
suffices  to  remove  the  disease.  It  is  then  a  heroic  means 
whose  advantages  can  be  rarely  appreciated  in  hospitals, 
where  the  patient  only  arrives  some  time  after  the  invasion, 
but  which,  in  civil  practice,  cannot  be  too  highly  recom¬ 
mended.  Sometimes  bleeding  does  not  remove  the  disease, 
still  it  is  not  less  happy  in  its  results.  As  the  blood  flows, 
the  patient  feels  his  respiration  less  obstructed,  expectora¬ 
tion  becomes  easier,  the  sputa  less  viscid  and  less  rusty. 
Then  the  pneumonia  resumes  its  course,  and,  if  the  bleeding 
is  repeated,  a  new  amelioration  results.” 

Yalleit  sums  up  the  use  of  bleeding  in  a  few  words,  and  as 
follows :  “  If  the  pulse  is  strong,  full  and  hard,  bleeding 
ought  to  be  insisted  upon  ;  if  it,  on  the  contrary,  becomes 
feeble,  small  and  contracted  venesection  should  be  re¬ 
nounced.” 

Louis,  who  certainly  cannot  be  accused  of  any  undue  bias 
towards  the  antiphlogistic  treatment,  thus  sums  up  his 
observations  :  1st.  That  blood-letting  has  a  happy  influence 
in  the  march  of  pneumonia ;  that  it  shortens  its  duration, 
but  that  this  influence  is  much  less  than  usually  imagined  ; 
that  the  patients  who  are  bled  in  the  first  few  days  recover, 
all  other  things  being  equal,  four  or  five  days  sooner  than 
those  who  are  bled  afterwards.  2nd.  That  pneumonia 
cannot  be  jugulated  by  means  of  bleeding,  unless  it  is  in  the 
first  days  of  the  disease.  3rd.  That  tartar  emetic  given  in 
haute  dose  when  bleeding,  appears  to  have  no  influence,  and, 
therefore,  the  cases  are  grave — has  a  favorable  action  and 
appears  to  diminish  the  mortality.” 

Lsennec,  whose  nice  ear  followed  the  increase  and  sub¬ 
sidence  of  pneumonia,  says  :  “  I  treated,  in  1824,  at  the 
clinic  of  the  Faculty,  with  tartar  emetic,  twenty-eight  cases  of 
pneumonia,  either  simple  or  complicated  by  slight  pleuritic 
effusion.  All  the  patients  were  cured  except  a  cachectic 
septuagenary,  who  had  already  fallen  into  senile  dementia, 
and  who  took  but  little  antimony  because  he  supported  it 
badly,  yet,  nevertheless,  the  most  of  these  cases  were  very 
grave.” 

No  little  of  this  antagonism  of  doctrine  and  practice  seems 
to  arise  from  the  fact  that  the  opposing  parties  are  speaking 
of  two  different  things — one  seems  to  be  writing  of  sthenic 
and  the  other  of  asthenic  pneumonia — diseases  as  far  apart 
as  the  antipodes.  The  reaction  in  the  one  case  is  vigorous — 
in  the  other  weak.  They  require,  of  course,  opposite 


42 


methods  of  treatment.  The  disagreement,  moreover,  gome-* 
times  arises  from  the  fact,  too  often  disregarded,  that  in 
malarious  districts  a  form  of  disease  is  recognized  of  which 
malaria  is  an  important  element — a  disease  arising  not  so 
much  from  deficiency  or  redundancy  of  blood  as  from 
poisoned  blood,  which  deranging  the  forces  regulating  the 
circulation  of  the  part,  gives  rise  to  hyperemia  and  inflam¬ 
mation.  In  this  disease,  bleeding  can  only  be  moderately 
employed  with  safety,  and  then  in  the  exacerbation.  Nor 
does  it,  like  all  other  malarial  diseases,  bear  alcoholic 
stimuli  well,  as  is  well  known  to  practitioners  in  malarial 
regions,  but  is  mainly  controlled  by  a  remedy  which,  though 
sedative  in  large  doses,  has  an  action  sui  generis  in  removing 
the  local  determinations  and  arresting  the  course  of  the 
febrile  malady,  of  which  they  are  the  local  expression. 

But  this  new  party,  as  they  term  themselves,  though  their 
doctrines  are  as  old  as  Arabian  medicine,  are  not  content 
with  advocating  their  treatment  as  applicable  to  the  diseases 
of  the  present.  They  desire  to  cast  odium  upon  the  past 
history  of  therapeutics,  thinking  thereby  to  glorify  them¬ 
selves.  According  to  their  views,  disease  has  never  changed 
in  the  character  of  its  reaction,  and  never  will ;  that  inflam¬ 
mation  is  always,  and  ever  will  be,  the  same, — a  position 
totally  untenable  as  regards  the  past,  and  merely  hypotheti¬ 
cal  in  reference  to  the  future.  It  need  not  excite  surprise,  if 
in  a  few  years,  they  are  found  advocating  bleeding,  tartar 
emetic  and  calomel.  They  certainly  must,  if  the  pulse  again 
becomes  full,  hard,  bounding  and  resistant  as  described  by 
the  old  authors  quoted  :  Now  it  is  soft ,  compressible ,  contracted 
and  frequent . 

But  in  claiming  that  the  recovery  of  their  patients  is  due 
to  nutriment,  they  forget  that  in  the  first  stage  of  acute 
internal  inflammation,  nutrition  is  impossible.  The  patient 
loathes  food,  and,  if  it  is  forced  upon  him,  his  stomach  cannot 
digest  it,  and  it  remains  there  a  foreign  body,  or  is  rejected 
by  vomiting.  The  very  fact  that  digestion  returns  after¬ 
wards,  is  a  proof  of  convalescence ,  not  of  cure  induced  by  it. 
When  healthy  appetite  returns,  disease  is  fleeing,  and  the 
capacity  for  nutrition  is  a  consequence ,  not  a  cause  of  the 
recovery  of  the  patient.  In  how  many  cases  of  acute  internal 
inflammation  can  you  succeed,  in  inducing  the  patient  te 
take  food  or  even  stimulants,  without  marked  aversion  if  not 
rejection  ?  Nearly  all  fevers  and  inflammations  commence 
with  nausea  and  vomiting,  furred  tongue,  anorexia,  more  or 
less  epigastric  tenderness,  constipation  or  unhealthy  stools  ; 
the  secretions  are  arrested,  diminished  or  prevented,  the 


43 


gastric  fluids  especially,  thus  rendering  assimilation  difficult 
or  impossible.  Do  not  these  facts  annihilate  the  theory  of 
the  stuffing  and  stimulating  treatment?  Does  not  the 
physiology  of  digestion  combine  with  the  enlightened 
experience  in  disease  of  every  unprejudiced  physician  in 
announcing  the  falsity  of  the  doctrines  of  this  so-called  new 
party  ?  Do  not  physiology  and  pathology  unite  with 
therapeutics  and  medical  experience  everywhere  in  over¬ 
whelming  Dr.  Norcom’s  misapplied  strength  of  alimentation 
and  stimulation  in  acute  internal  inflammation  ?  True,  the 
period  arrives  under  all  methods  of  treatment^  or  under  none 
at  all,  when  the  patient  requires  nourishment.  Then,  also, 
does  he,  as  a  general  rule,  desire  it.  But  I  repel  the  impu¬ 
tation  upon  the  great  men  of  our  profession  in  the  past,  that 
they  starved  their  patients,  and  did  not  have  sense  enough 
to  recognize  the  importance  of  “support,”  when  the  proper 
time  came  for  it.  That  physician  must  indeed  have  read 
the  past  records  of  medicine  with  but  little  profit  who  has 
not  found  that  all  judicious  men  seized  with  avidity  the  first 
opportunity  for  building  up  their  patients,  when  the  proper 
period  came.  Although  bleeding,  <fcc.,  may  have  been  the 
main  remedy,  yet  they  prescribed  it  under  certain  wise  rules, 
diminishing  it,  suspending  it,  and  even  rejecting  it  altogether, 
when  circumstances  of  age,  climate,  country,  locality,  consti¬ 
tution,  complications  and  anterior  conditions  were  opposed 
to  it.  The  change  in  the  character  of  disease  bearing  the 
same  name ,  is  recognized  by  the  great  masters  at  every 
period  in  the  history  of  medicine,  and  their  treatment  w^as 
varied  according  to  circumstances.  In  epidemics  of  acute 
fever  and  inflammation  of  an  asthenic  character,  bleeding 
was  renounced  by  physicians  a  thousand  years  ago,  and  a 
corresponding  medication  adopted.  History  denies  the 
right  of  any  one  to  pronounce  it  neiv,  and  repudiates  those 
who  now  claim  credit  for  originality. 

The  fear  of  bleeding  has  become  a  'phobia  of  the  day. 
As  before  intimated,  swarms  of  young  medical  graduates 
come  forth  every  Spring,  from  Northern  Medical  Colleges,  to 
settle  in  this  Southern  land,  their  minds  filled  with  prejudice 
at  their  institutions  against  venesection,  calomel,  <fcc.,  and 
boasting  of  the  superior  remedies  of  alimentation  and 
stimulation  in  the  treatment  of  our  Southern  fevers  and 
inflammations.  It  is  time  for  the  South  to  ask  whether  duty 
to  science  and  to  ourselves  does  not  require  a  change  in  this 
respect — whether  we  should  not  cease  to  patronize  medical 
heresies  and  to  seek  to  turn  the  tide  of  medical  pupilago  to 
our  own  languishing  schools,  whose  professors,  not  less  able 
F 


nor  skilful  than  the  ablest  of  the  North,  teach  doctrines 
generally  more  in  unison  with  the  laws  of  Southern  diseases 
and  the  experience  and  practice  of  enlightened  Southern 
practitioners.  Under  the  constant  influence  of  these  false 
teachings,  and  such  like  causes,  it  has  so  much  become  the 
fashion  not  to  bleed,  that  cases  imperatively  demanding  it 
often  suffer  and  die  from  its  neglect.  Men  do  not  die  so! 
easily  from  a  small  loss  of  blood  as  these  terror-stricken 
alarmists  imagine.  Look  how  many  cases  of  protracted' 
typhoid  fever  began:  to  improve  after  copious  hemorrhages 
from  the  nose  find  bowels !  Every  day  we  see  spontaneous 
hemorrhage  improving  the  condition  of  patients,  even  those 
suffering  from  tubercular  consumption.  Every  fall,  during 
the  prevalence '  of  those  high  congestive  fevers  of  malarial 
character  that  are  every  sickly  season,  more  or  less  com¬ 
mon  in  these  eastern  counties,  do  I  meet  with  cerebral- 
congestion  relieving  itself  by  hemorrhage  from  the  nose, 
when  proper  depletion  has  been  neglected  in  the  outset,  and 
without  which  depletion  or  spontaneous  hemorrhage  eleath- 
would  have  resulted. 

In  regard  to  the  expedient  method  of  treating  disease,  or 
what  amounts  to  the  same  thing,  Dr.  Norcom’s  plan  of 
treating  acute  internal  inflammation,  there  is  every  reason1 
to  believe  that  this  was  the  first  plan  adopted  in  the  infancy 
of  the  art  or  even  before  art  existed.  Men  of  course  ivere  led 
to  seek  for  remedies  because  of  the  results  of  non-treatment.  If 
the  'poiuers  of  nature  alone  had  been  found  efficient  to  control > 
and  cure  disease ,  of  course  no  one  would  have  ivished  for  more. 
But  it  must  have  been  because  this  was  not  the  case  ;  it  musk 
have  been  owing  to  the  fearful  and  fatal  results  of  disease 
when  left  to  the  unaided  powers  of  nature  that  men  eagerly 
sought  for  remedies.  Therefore  the  animal,  vegetable  and 
mineral  kingdoms  were  diligently  explored  to  find  relief  from 
pain  and  protection  from  death. 

It  is  fashionable  to  talk  about  a  neglect  of  the  study  of  the 
Natural  History  of  disease  being  prevalent,  but  from  the 
commencement  of  medicine  this  has  been  the  object  of  the 
greatest  physicians,  from  Hippocrates  down  to  Louis. 
What  better  or  more  numerous  examples  could  have  been 
wanting  than  in  the  thousands  of  patients  placed  upon  the 
gum  water  treatment  of  Brouissais  and  the  wholly  do-nothing 
treatment  of  Hahnemann !  And  yet  what  rational,  scientific 
man  of  the  present  day  is  content  with  the  results  of  their 
treatment?  What  admirable  pictures  of  the  Natural  History 
of  diseases  were  given  by  Hippocrates,  is  attested  by  every 
author  who  lias  perused  his  works.  What  masterly  delinea- 


45 


tions  of  the  same  were  given  by  Celsus  Aretaeus,  and  Galen, 
and  in  our  day  wlio  complains  of  the  clinical  histories  of 
disease  as  given  by  Louis,  Andral  and  Trousseau  ?  In  cases 
of  pneumonia  we  have  seen  that  Hippocrates  first  used 
simple  fomentations  before  bleeding.  Was  not  this  great 
man  able  to  discover  the  relative  value  of  expectation  and 
venesection  ?  Did  it  require  a  greater  genius  than  his  to 
determine  such  a  plain  matter  ?  It  was  clearly  because  men 
were  appalled  at  the  view  of  the  Natural  History  of  Disease, 
and  the  fatal  results  of  inaction  that  they  wrere  induced  to 
look  for  remedies.  Moderate  bleedings  were  often  tried  and 
failed,  when  subsequently  copious  bleedings  were  attended 
with  manifest  good  results.  We  have  clear  examples  of  this 
fact  in  the  case  of  Cleghorn,  army  Surgeon  and  lecturer  of 
anatomy  in  the  Universy  of  Dublin,  in  his  universally 
admired  and  classic  treatise  on  the  Diseases  of  Minorca.  He 
says  :  “  When  these  Pleurisies  first  became  epidemic  their 
quick  Progress  and  uncommon  mortality  surprised  me 
greatly.  I  attempted  to  cure  them  by  bleeding  once  or 
twice  a  Day  if  the  Complaint  were  violent,  as  I  had  always 
used  to  do  in  Inflammatory  Fevers.  But  the  Remissions  in 
the  mornings  sometimes  induced  me  to  omit  the  operation, 
and  the  Cessation  of  the  symptoms,  which  generally  hap¬ 
pened  about  the  third  day,  made  me  imagine  the  Danger  was 
over.  So  that  before  the  Patients  were  blooded  above  Twice 
or  three  Times,  the  Exacerbation  came  on  upon  the  fourth  or 
fifth  Days,  and  defeated  all  attempts  by  Bleeding,  Blistering, 
or  otherwise  to  relieve  them. 

“  These  unforeseen  Events  startled  me  greatly,  and  led  me 
again  to  review  the  whole  Progress  oi  the  Disease,  its  Symp¬ 
toms  and  Issue.  I  had  observed  that  some  escaped  by  means 
of  Expectoration  and  purulent  Urine  without  much  assistance 
from  Phlebotomy  ;  and,  considering  the  periodical  Revolution 
of  the  Fever,  the  quick  Transition  of  the  stitches,  from  one 
Part  to  another,  together  with  the  prevailing  Color  of  the 
Blood  as  well  as  that  of  the  Spitting  and  other  Excretions,  I 
was  apprehensive  that  these  were  what  Authors  call  bilious 
Pleurisies,  which  they  alledge  are  exasperated  by  large 
Evacuations,  particularly  Duretius  who  exclaims  with  gieat 
vehemence  against  those  Physicians  who  trust  principally  to 
Bleeding  in  the  cure  of  these  Diseases  without  waiting  toi 
the  natural  Evacuations.  These  motives  induced  me  to  use 
flie  Lancet  with  more  caution,  and  to.  rely  chiefly  on  the 
speedy  Application  of  Blisters  for  restraining  tne  mptoms. 
But  this  management  proved  less  successful  than  le 
former,  and  I  wras  convinced  in  a  short  time  teat  insteac  0 


46 


too  much,  too  little  Blood  had  been  taken  away  in  the 
beginning,  having  been  sometimes’ misled  by  the  insidious 
Intervals  of  the  Disease,  at  others  having  trusted  too  much 
to  the  faint  Attempts  which  Nature  made  to  relieve  herself  by 
Expectoration  and  Urine,  the  latter,  after  becoming  crude  on 
the  fourth  day  as  the  Delirium  advanced,  though  it  had 
promised  favorably  on  the  socond  or  third,  the  former 
frequently  being  checked  about  that  Period  of  the  Disease  by 
the  immoderate  Heat  of  the  Lungs,  rendering  the  matter 
viscid,  globular  and  not  to  be  discharged  but  with  the  utmost 
difficulty.  I  then  began  to  bleed  more  plentifully,  and 
repeated  it  so  as  to  take  away  thirty  or  forty  ounces  within 
the  three  first  days  of  the  Distemper ;  and  endeavoured  by 
bathing  the  legs  and  blistering  them  on  the  third  Day  to 
prevent  the  fatal  symptoms  from  coming  on  about  the  fourth 
or  fifth,  giving  Nitre  at  the  same  Time  liberally  and  Camphire 
in  small  Doses  to  promote  the  thinner  Secretions.  This 
method  succeeded  well  in  several  cases — Expectoration  and 
Urine  being  thereby  increased.” 

This  treatment,  however,  did  not  satisfy  this  eminent 
practitioner,  and  he  at  last  adopted  the  following,  as  given 
in  his  own  -words :  “If  I  was  called,  for  Example  in  the 
morning,  the  patient  was  immediately  laid  in  a  horizontal 
position  and  bled  at  the  Arm  until  his  pains  abated  or  he 
began  to  faint,  neither  of  which  commonly  happened  before 
sixteen,  twenty,  or  twenty-four  ounces  were  taken  away. 
If  the  Symptoms  continued,  I  ordered  about  the  same 
quantity  to  be  taken  from  the  other  Arm  in  the  Afternoon 
without  regarding  the  urine.  Expectoration  or  Appearances 
of  the  Blood,  next  Morning,  though  there  might  be  a  great 
Alteration  for  the  better,  yet  if  there  was  the  least  room  to 
suspect  that  any  Obstruction  remained  in  the  Head  or  Breast, 
the  Bleeding  was  repeated.  And,  by  carefully  weighing  the 
Blood,  I  found  that  between  forty-eight  and  fifty-four 
Ounces  were  frequently  taken  away  the  first  four  and  twenty 
Hours  of  my  Attendance.  This  sudden,  copious  Evacuation 
commonly  produced  a  cessation  of  all  violent  Symptoms, 
and  afforded  an  Opportunity  to  give  an  antiphlogistic  Purge 
the  next  day.  But  if  the  Symptoms  did  not  cease,  or  if  the 
Pains  and  difficulty  of  Breathing  returned  the  day  after  the 
Purge  had  been  given,  or  if  there  was  room  to  suspect  from 
the  Head-ache,  Giddiness,  Tingling  of  the  Ears  and  disturbed 
Best  that  the  Brain  was  in  danger  of  being  affected,  I  had 
again  immediate  Recourse  to  Bleeding,  taking  away  at 
different  Times  to  the  amount  of  twelve,  eighteen,  or  twenty- 
four  Ounces  in  the  space  of  a  day,  cither  by  the  Lancet  or 


Cupping  glasses  or  both,  as  occasion  required ;  by  which 
means  the  impending  Storm  was  happily  averted,  and  as 
soon  as  the  Commotions  were  quelled  tho  Purgative  repeated 
every  other  Day  for  three  times  unless  some  of  tho  critical 
Evacuations  appeared  with  such  visible  good  effects  as 
rendered  it  unnecessary.  In  this  manner  I  found  with 
Sydenham  that  Pleurisies  of  the  most  fatal  Tendency  might 
be  happily  cured  in  the  space  of  a  few  days,  and  with  as 
much  certainty  as  any  Distemper  whatever.  And  it  wTas  no 
less  remarkable  to  observe  how  quickly  the  Sick  recovered 
their  usual  Health  and  Strength  notwithstanding  the  great 
loss  of  Blood  they  had  sustained,  while  many  who  had  been 
bled  more  sparingly,  continued  in  a  languid,  infirm  state  for 
month,  without  being  able  to  get  rid  of  the  Cough  and  Pains 
in  the  Breast.”— -(Third  London  Edition,  1768.  The  Extract 
is  verbatim,  the  initial  letters  of  the  names  being  printed  in 
Capitals  in  the  old  English  Text,  as  it  now  continues  to  be 
in  the  German.) 

Dr.  Norcom  denies  (page  25  of  his  address)  that  there  has 
been  any  change  of  type  in  disease.  He  cannot  be  a  reliable 
witness  in  the  trial  of  this  important  cause  as  the  change 
occurred  before  he  began  to  practice.  What  physician  of 
acute  observation,  and  wdio  lias  grown  gray  in  medical 
service,  does  not  know  that  Dr.  Norcom  is  in  error  ?  Who 
that  is  conversant  with  the  History  of  Medicine  can  deny 
the  fact  of  this  change  ?  Is  not  an  ordinary  autumnal  Fever 
less  severe  in  character  and  of  shorter  duration  than 
formerly?  Where  is  the  respectable  sypliilographer  who 
wrill  deny  that  syphilis  is  a  mild  disease  compared  to  that  of 
former  days?  The  same  may  be  said  of  Small-Pox.  Is  it 
not  well  knowm  that  even  Asiatic  Cholera  is  much  more  fatal 
at  particular  times  than  at  others,  as  proven  by  statistics  ? 
Does  not  every  respectable  author  on  the  subject  know  that 
Yellow  Fever  is  sometimes  a  very  benignant,  and  at  other 
times  a  very  malignant  disease  ?  Of  the  latter,  witness  the 
epidemic  at  Norfolk  and  Portsmouth,  which  defied  all  treat¬ 
ment,  which  baffled  the  skill  of  the  illustrious  Warren  Stone 
as  well  as  others  of  the  most  distinguished  physicians  of 
New  Orleans,  Savannah,  Mobile  and  Charleston,  as  com¬ 
pletely  as  it  did  the  efforts  of  the  merest  tyro  of  the  profession. 
Does  not  the  habitual  endemic  of  this  and  of  Dr.  Norcom  s 
own  region  assume  various  types  and  degrees  of  violence  . 
Most  readily  will  the  practitioners  of  twenty-five  years 
experience  in  all  our  malarial  regions  answer  this  question 
in  the  affirmative.  Do  we  not  see  it  in  some  seasons 
.attended  with  a  short  cold  stage  and  prompt  vigorous 


48 


reaction,  anti  in  others  ushered  in  with  a  cold  stage  of  days 
duration  and  followed  by  imperfect  reaction  ?  Does  it  not 
.assume  the  intermittent,  remittent  and  continued  forms? 
Do  we  not  meet  in  some  malarial  seasons  more  than  at 
others  with  that  high  and  alarming  grade  of  cerebral  conges¬ 
tion,  attended  with  that  condition  of  pulse  so  apt  to  mislead 
and  deceive  the  unwary  and  inexperienced,  and  cause  the 
medical  attendant  perhaps  to  neglect  the  golden  opportunity 
for  rescuing  and  saving  his  patient  by  bold  and  decided 
treatment  ?  That  physician  who  lives  in  these  eastern 
counties  and  does  not  admit  this  and  such  as  this,  will  do 
well  to  commence  and  learn  over  again  the  alphabet  of  his 
Art,  or  begin  it  for  the  first  time.  Was  not  the  pulse  of  the 
pleurisies  and  pneumonias  of  former  days  as  described  by 
the  great  masters  of  medicine  hard,  full  and  resisting  ? 
Would  they  have  continued  to  bleed  if  the  lowering  treat¬ 
ment  tad  been  attended  with  such  deplorable  results  as 
described  by  Dr.  Norcom.  Authors  who  wrote  on  pneumonia 
twenty-five  or  thirty  years  ago,  describe  the  pulse  as  either 
hard  or  full  and  resisting  and  bearing  venesection  well.  Did 
not  Cullen,  Sydenham,  Boerliaave,  Chomel  and  Andral,  and 
hosts  of  other  observers  and  writers  in  ancient  and  modern 
times,  have  as  keen  perception  of  the  results  of  treatment  as 
Bennett,  Todd  and  Company  ?  To  ask  these  questions  is  to 
answer  them.  Let  Dr.  Norcom  observe  as  intelligently  and 
closely  and  laboriously  as  these  men,  and  his  reputation  is 
made.  They  were  no  idlers  nor  dreamers,  but  practical, 
sagacious,  acute  observers,  whose  pictures  of  disease  will 
forever  be  esteemed  as  master  pieces,  for  they  were  drawn 
from  Nature. 

Diseases  are  not  units.  Tho  same  disease  undergoes 
radical  changes.  Change  is  written  over  the  pages  of* 
creation.  It  is  a  part  of  the  sublime  system  of  our  Heavenly 
Father  for  governing  the  Universe  and  disposing  of  events. 
The  changing  seasons,  and  all  that  pertains  to  the  heavens 
above  and  the  earth  below  proclaim  this  wisely  ordained 
and  universal  law  of  Nature.  The  science  and  art  of  our  own 
profession,  as  attested  by  its  records,  makes  no  exemption  to 
the  law.  It  teaches  the  true  physician  not  alone  to  look  at 
the  name  of  disease,  or  its  anatomical  seat,  but  also  at  tho 
patient  as  influenced  by  age,  sex,  temperament,  diathesis, 
idiosyncrasy,  climate,  locality  and  seasons.  He  does  not 
bleed  all  his  patients  or  starve  them  all,  or  stimulate  them 
all,  but  is  guided  by  the  actual  condition  of  the  patient  at 
the  time  of  prescribing.  He  varies  his  treatment  according 
,to  circumstances,  and  is  not  overruled  in  his  judgment  by 


49 


any  exclusive  theory  or  blind  adherence  to  authority.  God,- 
as  a  general  rule ,  has  given  every  man  the  capacity  to  judge  for 
himself  as  well  as  to  receive  ideas  from  others,  and  he  is  an 
unprofitable  servant  who  does -not  maize  use  of  it. 

The  authorities  in  favor  of  the  change  of  type  theory  of 
disease  are  almost  innumerable  and  their  arguments  are 
unanswerable  and  overwhelming.  It  would  be  a  work  of 
supererogation  on  an  occasion  like  this,  and  an  unprofitable 
consumption  of  your  valuable  time  to  array  before  you  the 
hosts  of  medical  philosophers  and  able  and  successful  prac¬ 
titioners,  -who  bear  willing  testimony  to  its  truth.  Among* 
those  who  have  presented  the  subject  in  its  clearest  and  most 
convincing  light,  and  whose  arguments  are  most  conclusive' 
may  be  named  the  distinguished  Dr.  Aitkin,  the  able  author 
of  the  Science  and  Practice  of  Medicine,  in  volume  first,  page 
one  hundred  and  thirty -nine  and  following.  I  will,  in  addi¬ 
tion,  cite  the  testimony  of  a  former  practitioner  of  our  own 
State,  now  a  prominent  physician  of  Baltimore  and  well 
known  to  this  Society  as  one  of  the  able  Professors  of  the 
Faculty  of  Medicine  in  the  University  of  Maryland.  I  allude' 
to  Professor  William  T.  Howard.  In  a  controversy  with* 
another  eminent  medical  gentleman  formerly  of  our  State; 
also,  but  now  a  leading  physician  of  [Richmond  and  one  of 
the  most  distinguished  Professors  in  the  Richmond  Medical- 
College — Professor  Otis  F.  Manson.  Professor  Howard,  in1 
an  article  published  several  years  ago  in  the  North  Carolina 
Medical  Journal,  remarked  as  follows:  “Since  the  time  of1 
Hippocrates,  blood-letting  has  been  regarded  by  a  multitude 
of  physicians  as  the  remedium  magnum  in  pneumonia — to  be 
used  with  proper  discrimination  and  judgment ;  and  during 
all  this  lengthened  period,  observing  and  reflecting  men  have 
practised  it  largely,  moderately,  or  refrained  from  it  entirely,- 
according  to  the  status  of  the  vital  forces  in  each  individual- 
case.  Like  everything  else,  however,  blood-letting  has  been! 
used  in  every  age  to  great  excess ;  and  it  has  often  happened' 
that  a  profuse  and  preposterous  expenditure  of  the  vital  fluid 
has  driven  some,  who  witnessed  its  destructive  effects  thus 
practised  into  the  opposite  extreme,  of  abandoning  it  alto¬ 
gether.  Every  one  knows,  that  within  a  fewr  years  past,  a* 
great  change  has  taken  place  in  the  treatment  of  inflammatory 
diseases,  especially  hi  the  practice  of  bleeding;  and  that, 
although  formerly  it  was  the  rule  to  bleed  in  such  affections,- 
it  has  now  become  the  exception  and  is  rarely  resorted  to. 
This  change  in  practice,  admitted  on  all  hands,  has  been 
differently  accounted  for  by  different  observers.  Me  have, 
first,  Professor  J.  Hughes  Bennett  and  his  party  contending. 


50 


that  the  great  revolution  in  treatment  has  resulted  naturally 
from  the  great  advances  made  in  modern  times  in  diagnosis 
and  pathology.  Secondly,  The  late  Professor  Alison  and 
his  party  contending  that  the  type  of  disease  having  changed 
from  a  sthenic  to  an  asthenic  character,  the  practice  has 
very  properly  changed  accordingly ;  and  third,  Doctor 
Balfour  and  his  party  contending  that  the  change  has 
originated  from  neither  of  these  circumstances,  but  has  been 
forced  on  all  alike  by  the  results  of  a  successful  empiricism. 
Although  the  controversy  involves  the  treatment  of  inflamma* 
tion  in  general,  yet,  practically,  it  has  turned  almost  entirely 
on  the  treatment  of  pneumonia  by  blood-letting.” 

It  is  beside  our  purpose  to  discuss  these  questions  here. 
“  Suffice  it  to  say  that  with  Kennedy  we  believe  that  both 
animal  and  vegetable  life  is  subject  at  times  to  epidemic 
influences,  which  at  one  period  raise  and  at  another  depress 
the  standard  of  health ;  that  pneumonia,  like  fever,  alters  its 
type  at  certain  times,  and  that  no  single  plan  of  treatment 
can,  therefore,  possibly  meet  the  ever  varying  shades  of 
disease,  pneumonia  among  the  rest ;  or,  as  Watson  has 
expressed  it,  we  are  fully  persuaded  boih  by  our  own  obser¬ 
vation  and  the  records  of  medicine  that  there  are  waves  of 
time  through  which  the  sthenic  and  asthenic  characters  of 
disease  prevail  in  succession  ;  and  that  we  are  at  present 
living  amid  one  of  its  adynamic  phases.” — (N.  C.  Medical 
Journal,  March  1860. 

Again  :  At  the  same  time  Professor  Howard  continues,  as 
follows,  after  comparing  the  results  of  twenty-four  cases 
of  pneumonia  treated  by  M.  Grisolle,  in  eleven  of  wrhick 
bleeding  was  not  employed,  and  in  thirteen  of  the  number  it 
was  used  :  “  It  seems  to  me  that  no  one  can  compare  these 
two  series  of  cases  together  without  admitting  the  efficacy  of 
blood-letting  on  those  in  which  it  was  employed.  Having  so 
often  witnessed  in  suitable  cases  the  influence  of  bleeding  in 
reducing  the  force  and  frequency  of  the  pulse,  in  diminishing 
the  heat  of  the  skin  and  rendering  it  moist,  relieving 
delirium,  calming  restlessness,  relieving  head  ache,  lessening 
dyspnoea,  and  removing  or  greatly  moderating  the  pain  in 
pneumonia,  for  us  to  doubt  its  utility  w^ould  be  wholly  to 
discredit  the  evidence  of  our  own  senses.” 

Dr.  Norcom  publishes  his  Reform  doctrines  after  and  not 
before  the  Reformation.  Why  denounce  with  such  noisy 
clamor  the  antiphlogistic  treatment,  and  especially  blood¬ 
letting,  when  it  is  so  sparingly  used,  and  I  may  say  timidly 
employed  by  the  great  mass  of  the  profession  now,  and  has 
been  almost  abandoned  by  a  great  majority  of  physicians  ? 


51 


Aj3  evidence  of  this  change  and  of  a  correct  appreciation  of 
this  reactive  stage  of  disease,  I  may  refer  to  its  general 
recognition  by  those  who  commenced  their  career  years 
before  Dr.  Norcom  commenced  his.  Well  do  I  remember 
my  early  recognition  of  this  important  medical  truth  and  of 
my  corresponding  shape  of  treatment.  Let  us  refer  to  high 
authority  m  the  profession  of  this  and  of  other  States  in 
corroboration  of  this  statement. 

Professor  Manson,  already  referred  to,  and  recognized  by 
this  Society  as  on©  of  the  ablest  and  most  accomplished 
physicians  of  the  whole  country,  makes  the  following  state¬ 
ments  in  a  communication  to  the  Stethoscope  and  Virginia 
Medical  Gazette  of  February,  1851  :  “  Called  to  a  patient  in 
the  exacerbations  of  remittent  fever,  venesection  is  practised 
in  every  case  where  the  pulse  wall  justify  it,  but  it  is  rarely 
that  this  is  called  for.  In  fact  the  general  experience  of  myself 
and  confreres  is  adverse  to  the  use  of  the  lancet  in  this  affec¬ 
tion.  The  pulse,  though  often  full  and  apparently  tense,  is 
generally  compressible .  Local  bleeding  by  cups  and  leeches 
will  usually  be  sufficient,  and  if  there  is  tenderness  on 
abdominal  pressure  or  other  symptoms  of  visceral  complica¬ 
tion  these  should  be  freely  applied.  Should  symptoms  of 
cerebral  irritation  be  present,  a  copious  flow  of  blood  wall  bo 
obtained  by  cups  to  the  mastoidal  regions.” 

In  an  article  on  malarial  pneumonia,  published  in  our 
Transactions  for  the  year  1857,  and  written  for  the  Society 
by  the  same  careful  observer,  he  says  :  that  “  the  pulse  which 
had  been  very  frequent  and  contracted  in  the  chill  becomes 
expanded,  acquires  force,  and  sometimes,  though  rarely , 
becomes  full  or  tense.  The  term  compressible  applies  to  the 
usual  condition  of  pulse  and  the  idea  entertained  on  its 
careful  examination  is  that  the  heart  is  acting  with  only  a 
seeming  force  and  not  with  real  vigor.”  When  speaking  of 
the  treatment,  he  remarks  as  follows  :  “If  the  pulse  is  hard, 
full  or  tense,  as  it  is  in  rare  and  exceptional  cases,  or  if  the 
patient  is  robust  or  previously  healthy  and  possessing 
ordinary  vigor,  and  the  pain  or  dyspnoea  is  very  intense  and 
the  character  of  the  pulse  or  other  symptoms  do  not  decid¬ 
edly  contraindicate  its  employment,  then  a  moderate  quantity 
of  blood  may  be  taken  from  the  arm.  In  this  diseaso 
goneral  blood-letting  should  be  employed  with  a  view  only  to 
moderate  and  not  with  an  expectation  to  cut  short  the  disease ; 
nor  should  it  be  employed  except  in  the  instances  referred 
to.  In  cases  where  this  is  not  followed  by  marked  relief, 
and  in  those  where  venesection  is  inadmissible,  the  local 
abstraction  of  blood  by  cups  or  leeches  should  be  resorted  to 

Gr 


and  may  be  used  as  freely  as  considerations  of  safety  will 
permit.  Tlie  time  at  which  bleeding  by  any  mode  should  be 
practised,  is  that  period  when  the  exacerbation  has  reached 
its  acme,  which  is  almost  invariably  in  the  afternoon  or 
evening.” 

These  and  other  extracts  that  might  be  given  from  other 
authors  show  how  careful  blood-letting  was  used  twenty 
years  ago,  when  but  few,  if  any  of  us,  who  were  then  coming 
upon  the  stage  of  action  had  ever  heard  of  the  doctrines  of 
Bennett,  Todd  &  Co. 

As  to  the  employment  of  the  expectant  treatment,  and  the 
use  of  stimulants  in  malarial  fevers,  and  their  complications 
— the  endemic  affections  of  Dr.  Norcom’s  own  immediate 
region — I  feel  authorized  to  warn  the  practitioner  against 
the  habitual  application  of  such  practice.  Except  as  a  tem¬ 
porary  means  of  support  after  these  fevers  have  been  broken 
up,  or  as  an  auxiliary  in  sustaining  the  vital  forces  in  some 
cases  of  neglected  treatment,  while  other  efforts  are  being 
made  to  induce  the  action  upon  the  system  of  more  curative 
remedies,  I  do  not  believe  there  can  be  found  a  single  expe¬ 
rienced  and  judicious  practitioner  who  will  uphold  the  gene¬ 
ral  employment  of  stimulants,  even  in  those  cases  in  which, 
from  the  very  outset,  there  is  prostration  of  the  vital  pow¬ 
ers.  If  a  physician  gives  brandy  in  the  cold  stage  of  -con¬ 
gestive  fever,  it  will  end  fatally  in  a  large  majority  of 
cases ;  and,  as  to  alimentation  in  the  cold  or  hot  stage, 
that  is  but  little  less  than  preposterous.  Bather  do  I  agree 
with  the  lamented  Dr.  Drake,  so  justly  regarded  in  his 
day  as  the  Nestor  of  the  profession  in  the  Northwestern  States. 
Guided  not  only  by  his  own  observation,  but  by  that  of  near¬ 
ly  every  physician  of  note  from  the  Great  Lakes  to  the  Gulf 
of  Mexico,  we  have  his  high  authority  against  the  use  of 
stimulants  in  these  instances.  In  his  celebrated  work  on  the 
“Diseases  of  the  Interior  Yalley  of  North  America,  ’  second 
series,  he  remarks,  page  86,?  in  treating  of  “  internal  stimu- 
lents  ”  in  “malignant  Intermittent  Eevers,”  that  “almost 
every  kind  of  excitant  and  norcotico-stimulant  has  been  ad¬ 
ministered  internally  in  the  cold  stage.  In  this  stage  of  the 
paroxysm  of  malignant  intermittent  fever,  wine,  brandy, 
whisky,  and  other  alcoholic  drinks  have  been  liberally  given ; 
but  the  results  have  not  been  such  as  to  commend  them. 
They  probably  act  upon  the  brain  unfavorably.” 

I  have  seen  patients  in  the  protracted  cold  stage  of  remit¬ 
tent  fever,  with  claj-cold  skin  and  feeble  pulse,  become  colder 
and  colder  under  the  influence  of  stimulants.  When  reaction 
followed  their  use  I  have  seen  them  die  in  apopletic  convul- 


moils.  "Were  we  to  bo  guiclecl  by  any  a  priori  theory,  de¬ 
duced  from  physiology,  m  our  treatment  of  malarial  "fever, 
we  should  certainly  expect  stimulants  to  be  useful  in  those 
cases  where  the  vital  powers  were  prostrate  and  the  pulse 
flagging ;  but  every  sensible  practitioner  is  perfectly  aware 
that  they.are  either  generally  inert  or  hazardous.  If  the  young 
men  coming  into  practice  in  the  malarious  regions  of  North 
Carolina,  depend  upon  stimulants  and  alimentation  in  the 
treatment  of  Periodical  Fevers,  they  will  soon  be^  compelled, 
like  the  followers  of  Jack  o’  Lantern,  to  find  themselves  in  a 
bog,  and  their  patients  in  premature  graves. 

Other  vulnerable  points  in  Dr.  Norcom’s  Address  consist 
in  his  omission  to  make  any  distinction  in  his  views  as  to  the 
sthenic  and  asthenic  states  in  inflammation.  We  look  in 
wain  for  an  exposition  of  his  sentiments  as  to  the  treatment 
of  many  of  our  every-day  acute  diseases.  How  would  he 
treat  cholera  infantum,  comatose  remittent  fever,  or  Asiatic 
cholera  ?  Would  he  bring  to  bear  his  batteries  of  food  and 
brandy  ?  How  long  would  his  patients  live  under  such 
treatment  ?  Hoy/  would  he  treat  acute  gastritis,  entiritis, 
nephritis,  or  cystitis  ?  With  food  and  brandy  ?  Would  not 
the  grave  soon  claim  and  receive  them  under  such  manage¬ 
ment  ?  How  would  he  treat  iritis  or  retinitis  ?  With  food 
and  brandy  ?  How  long  would  his  patient  be  able  to  grope 
his  way  out  of  perpetual  darkness  ?  Why  should  Dr.  Nor- 
com,  at  this  late  day,  declaim  against  wholesale  blood-letting 
and  the  abuse  of  calomel  and  antimony,  as  such  treatment 
had  been  abandoned  before  he  graduated  by  every  correct 
medical  thinker  and  accurate  observer  ?  Let  him  take  heed, 
clever  man  as  he  is,  that  he  does  not  allow  himself  to  be 
ranked  among  that  too  numerous  class  of  the  present  day, 
who  set  up  men  of  straw  for  the  glory  of  knocking  them 
down.  Is  he  aware  that  his  onslaughts  upon  anti-plogistic 
remedies  contain  unmerited  strictures  upon  the  practice  of 
his  own  honored  and  lamented  father.  Dr.  James  Norcom? 
He,  too,  resided  in  Edenton,  in  this  State,  was  a  gentleman 
of  profound  erudition  and  high  accomplishments,  and  one  of 
the  most  distinguished  pfiiysicians  in  the  whole  country,  as 
lie  certainly  was  one  of  the  most  successful  practitioners.  I 
cherish  a  peculiar  pride  and  gratification  in  the  belief  that 
at,  and  for  many  years  prior  to,  his  death,  ho  was  at  the  head 
of  the  profession  in  North  Carolina.  What  were  his  views  of 
disease  before  the  rolling  in  upon  us  of  the  “  adynamic 
waves  of  the  change  of  type?”  Listen  to  what  ho  says  in 
some  “  Observations  on  the  Influenza,  as  it  appeared  at 
Edenton,  N.  C.,”  in  a  letter  to  Dr.  Kush,  of  Philadelphia, 


£4 


published  in  the  Philadelphia  Medical  Museum  in  1808,  vol¬ 
ume  five,  page  118.  “  Since  I  returned  to  North  Carolina  I 

have  been  engaged  in  business  with  Dr.  Sawyer,  and  have 
had  a  respectable  practice,  and  enjoyed  a  greater  degree  of 
success  than  I  ever  before  experienced.  In  the  Influenza, 
which  prevailed  here  from  the  last  of  September  until  the 
beginning  of  the  year,  I  hardly  lost  a  patient.  The  disease, 
in  its  form  and  character,  resembled  very  nearly  that  which 
you  have  described  in  your  Medical  Inquiries.  It  was  uni¬ 
versally  inflammatory  and  uniformly  yielded  to  depletion. 

“  There  appeared  to  me  to  be  in  the  course  of  the  season  a 
greater  proportion  of  cases  with  pulmonary  determination 
than  is  common,  and  some  of  the  most  inflammatory  I  ever 
saw.  One  patient  I  bled  seven  times  largely  in  forty-eight 
hours,  and  another  three  times  in  eight  hours.  The  event  in 
both  cases  was  favorable.  It  was  my  happy  lot  to  be  instru¬ 
mental  in  saving  the  life  of  an  amiable  woman  through 
a  series  of  relapses  by,  I  am  sure,  not  less  than  fifty  bleedings. 
Bleeding,  I  found,  in  all  cases  of  violence,  an  antidote  to  the 
disease,  and  in  milder  cases  less  direct  and  less  active  evac- 
uants  never  failed  to  cure. 

“  The  most  fatal  consequences  of  the  fever,  when  it  was 
not  properly  treated  or  speedily  cured,  were  dropsy  and 
consumption.  Few  of  these  have  fallen  to  my  share  for  a 
reason  I  have  assigned  already.  In  the  dropsies  that  have 
occurred  within  my  observation,  my  practice  has  been 
happy.  The  lancet,  purging,  nitre  and  sage  tea,  cream 
of  tartar  and  mercury,  have  been  my  remedies.  And  in  con¬ 
sumption  I  have  cured  and  relieved  more  patients  than 
I  ever  saw  cured,  according  to  the  number  I  have  attended. 
My  remedies  have  been  the  lancet,  opium,  camphor,  hore- 
hound  and  salivation.”  Thus  do  we  introduce  against  Dr. 
Norcom,  and  in  favor  of  the  change  of  type  theory,  not  alone 
the  conclusive  and  overpowering  testimony  of  his  own  dear 
father,  but  we  could  go  on  and  pile  authority  upon  authority, 
equally  strong  and  convincing,  in  support  of  the  positions  we 
have  taken  in  this  paper.  We  have  introduced  our  wit¬ 
nesses,  not  to  advocate  the  propriety  of  their  practice  at  this 
day — for,  were  they  now  in  practice,  they  would  make  it  cor¬ 
respond  to  the  indications  of  the  prevailing  character  of  the 
disease — but  our  main  object  is  to  show  how  idle  are 
the  fears  of  those  who  condemn  moderate  and  judicious 
venesection. 

In  relation  to  the  general  character  of  Inflammation, 
Dr.  Norcom  seems  to  differ  in  his  views  with  those  of 
standard  authors  and  the  ablest  writers.  Assuming  that  it  is 


unnecessary  to  diminish  the  amount  of  blood  in  an  inflamed 
tissue,  he  asks  :  “  Can  general  blood-letting  diminish  the 
amount  of  blood  in  an  inflamed  part  ?”  In  inflammatory 
action  of  the  contents  of  the  three  great  cavities  of  the  head, 
chest  and  abdomen,  it  is  found,  according  to  high  authority, 
that  blood-letting  not  only  diminishes  the  quantity  of  blood 
circulating  in  the  vessels,  but  at  the  same  time  calms 
the  turbulent  action  of  the  heart  and  arteries.  It  is  admit¬ 
ted  that  in  external  inflammation,  so  liable  to  be  diffused,  the 
lancet  should  be  used  with  great  caution,  lest  by  too  free 
a  detraction  of  blood  the  constitutional  symptoms  already 
existing  may  be  converted  into  fever  of  a  different  type  or 
character.  Blood-letting  in  internal  inflammations  not  only 
diminishes  the  mass  of  circulating  fluids,  but  is  advantageous 
in  the  inflammation  of  external  parts  by  drawing  blood  from 
the  larger  vessels  going  ?more  immediately  to,  or  returning 
from,  these  parts.  It  is  here  that  the  salutary  influence 
of  venesection  is  sure,  and  does  not  act,  as  Dr.  Norcom 
insists,  by  materially  weakening  the  force  of  the  heart’s 
action.  A  true  interpreter  of  vital  phenomena,  a  judicious 
observer,  a  stranger  to  the  exactions  of  mere  party  systems, 
and  unseduced  by  the  subtleties  of  the  schools,  clearly 
understands  that,  when  the  excitability  of  the  sanguineous 
system  is  carried  to  a  very  high  degree,  blood-letting  not 
only  diminishes  the  amount  of  blood,  but  in  other  respects 
proves  highly  beneficial.  His  assertion  that  during  in¬ 
flammation  the  vessels  lose  their  contractile  power,  and 
are  distended  with  blood,  and  that  stasis,  owing  to  adhesive¬ 
ness  of  the  corpuscles,  occurs,  and  is  followed  by  exuda¬ 
tion,  will  not  be  accepted.  The  vessels  do  not  lose  their  con¬ 
tractile  power  from  this  cause,  but  during  inflammation,  the 
blood  ceases  to  undergo  its  changes  to  the  proper  extent 
from  arterial  into  venous,  and  the  functions  of  nutrition  and 
secretion  are  to  a  very  great  extent  suspended.  On  the 
inner  surface  of  the  walls  of  the  dilated  vessels  colorless 
corpuscles  are  said  to  collect  sometimes ;  but  there  are  no 
new  formations  called  forth  by  this  change — they  already 
exist  in  the  blood,  and  when  the  velocity  of  the  current 
is  materially  increased  they  mingle  with  the  red  corpus¬ 
cles,  and  are  carried  along  with  them.  It  is  not  established 
that  stasis  is  followed  by  exudation,  for  the  reason  that 
new  canals  are  formed  by  globules  of  blood  bursting  through 
the  sides  of  a  vessel,  and  forcing  a  passage  for  them¬ 
selves  through  the  cellular  texture  into  another  vessel.  A 
considerable  number  of  new  canals  are  sometimes  formed  by 
this  process  of  nature  through  which  the  blood  continues  to 


5G 


circulate.  It  is  surely  not  rational  or  philosophic  to  apply 
to  these  varied  phenomena  any  other  hypothesis  than  the 
one  of  increased  or  diminished  action.  It  appears  also  in¬ 
correct  to  describe  vessels  which  performed  their  functions 
efficiently  during  health,  as  affected  with  direct  debility 
because  they  are  unable  to  perform  double  their  usual  labor 
with  equal  efficiency  in  disease.  It  cannot  be  denied  that, 
unless  under  peculiar  circumstances — forming  exceptions  to 
the  general  rule — the  action  of  the  vessels  is  at  first  greatly 
and  powerfully  increased ;  and  it  is  only  when  they  become 
clogged  and  over-distended  by  an  excess  of  blood,  and  that, 
too,  thinner  and  more  fluid  than  that  which  they  contain  in 
health,  which  being  no  longer  able  to  contract,  become 
passive  ;  but  it  is  not  occasioned  in  consequence  of  injury  to 
the  vaso  motor  nerves  of  the  part  as,  he  contends.  Adhesive¬ 
ness  of  the  corpuscles  cannot,  therefore,  be  correctly  admit¬ 
ted  as  the  cause  of  the  distension  of  the  vessels — thereby 
causing  debility- — since  we  only  perceive  this  to  occur  as  a 
secondary  effect.  Weak  and  relaxed  vessels  are  themselves 
susceptible  of  increased  action,  and  often  in  a  much  greater 
degree  than  vessels  in  an  opposite  state ;  for  it  is  well  known 
that  constitutions  in  which  the  fibre  is  lax  and  delicate  are 
generally  characterized  by  a  much  higher  degree  of  mobility 
and  irritability,  and  are  much  more  predisposed  to  inflamma¬ 
tion  than  constitutions  endowed  with  a  more  firm  and  rigid 
texture  of  the  solids.  While  delicate  and  sensitive  vessels 
are  easily  roused  into  excessive  action,  they  are  less  able  to 
sustain  it,  and  are,  therefore,  more  readily  overcome  by  the 
increased  flow  of  blood,  and  more  quickly  affected  with 
inflammation. 

Nor  will  Dr.  Norcom,  in  the  assumption  that  there  is  no 
direct  anastomosis  between  the  surface  vessels  and  the 
inflamed  part,  and  therefore  that  cupping  in  inflammation 
is  not  profitable,  secure  the  concurrence  of  his  professional 
brethren.  Let  us  see  how  this  is.  When  a  stimulus  is 
applied  to  a  living  part,  the  first  effect  produced  is  an  excite¬ 
ment  of  the  sensibility  of  the  part  and  a  consequent  degree 
of  pain.  The  necessary  result  of  this  morbid  excitement  of 
the  sensibility  and  contractility  of  the  vessels  is  a  more  rapid 
flow  of  blood  to  the  part,  which  acting  as  a  stimulant  tends 
still  more  to  quicken  the  circulation.  There  is,  consequently, 
a  considerable  influx  of  blood  in  all  the  vessels,  capillaries 
and  veins,  to  the  amount  of  double  the  usual  quantity.  This 
is  precisely  the  action  which  takes  place  in  inflammations — 
the  surface  vessels  in  most  cases  anastomosing  with  those  of 
the  inflamed  part.  His  opposition,  therefore,  to  cupping 


cannot  bo  sustained,  and  is  founded  upon  an  anatomical 
error,  in  part,  because,  while  it  is  in  some  parts  of  tbfc  sur¬ 
face  true,  that  the  vessels  from  which  the  blood  is  withdrawn 
have  no  anatomical  connexion  with  those  inflamed  beneath, 
it  is  equally  untrue  as  respects  other  parts.  In  all  these 
cases  of  cupping,  however,  let  it  not  be  forgotten,  whether 
there  is  or  is  not  any  direct  anastomosis,  that  there  is  a 
sympathy  existing  through  the  great  organic  nervous  centres,, 
between  the  outer  and  inner  surface  or  organ,  by  which  any 
impression  made  upon  the  former  is  communicated  to  the 
latter.  Herein  consists  a  conservative  law  of  useful  results- 
that  the  experience  of  every  enlightened  practitioner  must 
have  observed.  It  is  recognized  in  the  fact  that,  amid  all  the 
fluctuations  of  general  blood-letting,  the  local  abstraction  by 
leeching  and  cupping  has  maintained  its  ground  with  more 
consistent  uniformity.  Local  bleeding  is  an  invaluable 
remedy  under  various  circumstances  of  disease.  When  there 
is  not  much  general  excitement,  but  troublesome  local  con¬ 
gestion  or  inflammation ;  in  other  cases  when  general 
depletion  has  reduced  the  fullness  of  the  pulse  and  moving 
forces  of  the  blood  with  still  a  co-existent  local  inflammation 
and  again,  where  the  reasons  for  and  against  the  use  of  the 
lancet  are  so  equal  that  it  is  difficult  to  determine  as  to  its 
use,  as  in  many  cases  of  fever  attended  with  inflammations ; 
in  these  and  similar  circumstances  we  can  often  use  cupping 
with  the  happiest  results,  even  restoring  health  and  saving 
life  thereby  in  certain  cases.  No  one  conversant  with  the 
effects  of  both  general  and  local  bleeding  will  deny,  that  a 
certain  quantity  of  blood  taken  from  an  inflamed  part  or 
near  by,  lias  decidedly  more  effect  on  the  disease  than  a  like 
quantity  abstracted  elsewhere. 

CALOMEL. 

Not  more  unsparing  and  persistent  have  been  the  attacks 
of  Todd,  Bennett  &  Co.,  upon  venesection  than  are  their 
denunciations  of  the  various  forms  of  Mercury.  If  calomel 
deserves  one-thousandth  part  of  the  anathemas  which  these 
and  other  extremists  have  so  long  hurled  against  its  use, 
surely  it  should  long  since  have  been  expelled  from  the 
Materia  Medica.  After  all  its  ups  and  downs  in  professional 
appreciation,  the  “  much  abused  Mercury”  still  maintains  its 
stronghold  upon  the  profession.  True,  it  has  been  morn 
sparingly  used  in  the  Southern  States,,  within  the  last  twenty- 
five  or  thirty  years,  and  for  the  following  reasons:  Tte 
prevailing  endemic  and  epidemic  diseases  were,  before  and 
since  that  time,  of  malarial  origin,  yet  the  powers  oi  quinine- 


58 


were  not  so  generally  known  as  now.  In  the  simple  inter- 
mittents  with  a  stage  of  complete  apyrexia  ancl  in  the  benign 
forms  of  remittent  fever,  in  which  the  remissions  were 
decidedly  manifest,  quinine  in  small  doses  was  administered 
by  physicians  generally  ;  but  in  the  violent  cases  in  which 
the  remissions  were  not  evident,  and  in  which  symptoms  of 
cerebral  or  gastro-enteric  irritation,  congestion,  and  inflam¬ 
mation,  were  either  singly  or  unitedly  present — in  tho  large 
majority  of  cases  quinine,  except  by  a  very  few  physicians, 
was  usually  withheld.  In  these  cases,  mercury  was  almost 
universally  given.  It  is  well  known  that  the  patient  was 
usually  pronounced  “  safe”  as  soon  as  ptyalism  in  the 
slightest  degree  presented  itself.  It  vms  objected  to  the 
mercurial  treatment  that  it  was  too  slow  and  uncertain  in 
the  rapid  and  malignant  cases,  and  was  attended  with  the 
injurious  consequences  often  of  ptyalism,  nevertheless,  the 
mercurial  treatment  proved  highly  successful  in  the  hands 
of  experienced  and  judicious  practitioners.  The  malignant 
cases  which  defied  its  powers  were  not  so  numerous  as  might 
be  supposed,  while  the  evil  consequences  of  mercurialization 
were  in  many  cases  exaggerated,  the  majority  of  cases  soon 
recovering  from  its  effects  entirely.  Even  after  the  intro¬ 
duction  of  the  use  of  large  doses  of  quinine,  calomel  continued 
to  be  necessary  in  completing  the  cure,  and  is  still  regarded 
as  a  most  valuable  adjuvant. 

In  pneumonia  calomel  is  regarded  as  a  most  excellent 
remedy  in  skilful  hands.  In  all  my  practice  I  can,  with 
truth,  say  that  I  have  seen  but  few  cases  of  pneumonia  die 
where  the  patient  was  clearly  and  timely  brought  under  its 
influence.  I  have  also  seen  its  great  beneficial  influence  in 
Dysentery,  Diarrhoea,  Cholera  Infantum,  and  many  others 
of  our  endemic  diseases.  Tho  best,  the  ablest,  the  most 
successful  practitioners  of  tljis  and  ev-ery  other  portion  of 
the  South  have  always  regarded  mercury  as  a  useful  and 
most  important  remedy  in  our  Southern  diseases  generally. 
In  Syphilis,  though  for  a  time  it  fell  into  some  disrepute 
under  the  opposition  of  prominent  men,  yet,  it  still  holds 
its  place  in  the  therapeutics  of  nearly  every  modern 
Sypliylographer. 

Even  the  French,  who  have  the  greatest  prejudices  against 
it  of  any  other  people,  have  been  compelled  to  return  to  its 
use  in  true  chancre.  Jticord  still  recommends  it  as  the 
principal  remedy.  It  is.true  that  tho  use  of  mercury,  even 
m  moderate  quantities,  is  sometimes  attended  with  unpleas¬ 
ant  and  injurious  consequences.  It  is  true  that  the  habit 
which  too  many  of  our  farmers  and  others  still  pursue  of 


•59 


\ 


* 


keeping  calomel  in  their  houses  bj  the  pound,  and  of  dealing 
it  out  to  their  families  and  themselves  profusely,  even 
sometimes  by  the  teaspoonful,  and  for  almost  any  and  every 
complaint,  is  highly  injurious  and  amounts  to  a  deplorablo 
evil ;  for,  by  the  disintegration  and  disorganization  of  the 
blood  frequently  induced  by  such  mal-practice,  the  constitu¬ 
tions  of  their  children  are  often  undermined  and  ruined,  and 
other  bad  consequences  entailed.  But  this  is  the  abuse 
and  not  the  proper  use  of  this  potent  remedy.  The  same 
can  be  said  of  nearly  every  other  active  agent  in  the  Materia 
Medica.  Opium,  Arsenic,  Strychnine,  Iodine,  Chloroform, 
&c.,  are  sometimes  not  only  injurious  but  fatal  in  their  effects 
in  the  best  of  hands.  But  we  are  unable  to  discard  them 
until  better  agents  are  provided.  Of  one  fact  we  may  be 
fully  assured,  and  that  is,  neither  food  or  whiskey  can  ever 
supply  the  place  of  calomel  or  the  other  remedies  in  a  larger 
majority  of  cases  of  disease  we  are  called  upon  to  treat. 
When  the  ^oi -distant  Modern  Revolutionists  in  Medicine 
supply  us  with  better  remedies  than  those  we  have  we  will 
discard  them,  and  not  until  then .  While  I  am  ready  with  Dr. 
Norcom  to  concede  it  as  “  certain  that  improvements  in 
pathology  must  follow  in  the  wake  of  an  advancing  physi¬ 
ology,”  yet,  in  the  face  of  all  the  discoveries  and  improve¬ 
ments  that  have  been  made  in  these  departments,  I  utterly 
deny  that  the  treatment  of  Acute  Internal  Inflammations 
can  be  based  upon  our  present  knowledge  of  them.  Decry 
empiricism  as  we  may,  yet,  the  knowledge  of  the  great  value 
of  thereapeutic  agents  is  chiefly  due  to  experience,  and  obser¬ 
vation.  Vaccination,  quinine,  opium,  arsenic,  iodine, 
mercury  and  a  host  of  other  remedies — the  best .  we  have 
indeea l — were  never,  and  could  never  have  been,  indicated  or 
dreamed  of  by  physiologists  or  pathologists.  And  they  will 
continue  to  be  employed  by  all  endowed  with  common  sense 
until  greater  experience  and  larger  observation  have  given 
us  better.  With  all  our  boasted  knowledge  of  Inflammation, 
yet,  after  all,  how  little  do  wo  really  know  of  its  essential 
nature  ?  Do  the  microscopic  phenomena,  as  observed  in  the 
web  of  the  frog’s  foot,  tell  you  anything  of  the  specific  nature 
of  the  varieties  of  inflammation,  of  the  causes  or  cure,  ?  How 
idle  then  to  attempt  to  baso  the  art  of  medicine  upon 
Physiology  or  Pathological  Anatomy !  They  aro  simply 
accessories — aids — but  not  tho  corner  stones  of  Therapeutics. 
Dispute  as  we  will  about  the  modus  operandi  of  medicines, 
yet,  quinine  still  as  certainly  annihilates  malarial  diseases, 
opium  relieves  pain  and  produces  sleep,  and  mercury  cures 
inflammation  and  syphilis .  The  art  of  medicine  is  bascc 

II 


66 


upon  the  accumulated  facts  and  observations  of  ages.  It* 
rules  and  principles  are  simply  derived  from  these  sources. 
Call  it  empiricism,  or  what  you  will,  it  is  the  nearest  approach 
to  Truth  bequeathed  to  us  and  can  never  be  superseded  by 
the  Cook  and  Distiller  of  the  theory  of  Alimentation  and 
Stimulation.  It  is  as  irrational  to  declaim  against  the  use  of 
bleeding,  mercury  and  tartar  emetic  because  they  are  some¬ 
times  injudiciously  employed,  as  it  is  to  denounce  food  and 
wine  and  whiskey,  because  their  abuse  leads  to  gout,  intem¬ 
perance,  delirium  tremens,  paralysis  and  death. 

The  high  claims  set  up  by  the  friends  of  mercury,  as  to  its 
beneficial  effects  in  subduing  inflammation  and  other 
diseases,  and  its  adaptation  especially  to  malarial  fevers  and 
affections  of  the  liver,  are  disputed  by  its  opponents.  They 
deny  it  has  any  cholagogue  action,  most  of  them,  and  will 
not  admit  the  theory  of  its  absorption  into  the  system.  Todd, 
Bennett  &  Co.  are  noted  for  their  opposition  to  calomel  in 
these  relations,  and  the  boldness  of  their  denial  of  its  reputed 
virtues  in  inflammatory  diseases  and  In  acting  upon  the 
liver  is  very  injurious  to  the  cause  of  medical  truth,  especially 
in  the  case  of  many  young  and  inexperienced  members  of 
the  profession.  Committees  of  prominent  European  medical 
men  have  been  appointed  to  make  special  investigations  of 
the  action  of  these  mercurial  preparations  upon  the  human 
system,  and  to  enquire  into  the  important  question  of  their 
absorption.  After  elaborate  enquiries  and  protracted  labors 
directed  to  a  knowledge  of  the  action  of  mercury  upon  dogs 
and  other  inferior  animals,  and  as  far  as  possible  upon  man, 
embracing  the  feature  of  absorption,  these  gentlemen  report¬ 
ed  very  unfavorably  as  to  its  action  and  value.  It  is  even 
denied  that  it  is  absorbed  into  the  human  system,  and  the 
denial  is  willingly  caught  up  by  the  opponents  of  calomel, 
and  they  are  seeking  to  get  up  a  greater  hue  and  cry  than 
ever  before  against  it.  Their  experiments  upon  inferior 
animals  are  very  fine  illustrations  of  their  devotion  to  physi¬ 
ology,  and  their  fine  spun  theory  as  to  the  impossibility  of 
introducing  into  the  system  by  absorption,  or  any  other 
possible  way,  globules  or  particles,  however  small  or 
minutely  reduced,  of  any  preparation  of  mercury,  reads  well 
enough  on  paper,  but  unfortunately  for  their  reasoning  and 
conclusions,  are  overthrown  by  innumerable  and  overwhelm¬ 
ing  facts  to  the  contrary.  Let  us  apply  the  test  of  medical 
logic  and  of  scientific  induction  to  this  question,  and  proceed 
to  examine  it  fairly  and  clearly. 

I  have  often  seen  under  the  operation  of  calomel  almost 
apparently  pure  bile  discharged  by  stool,  and  often  have  I 


•seen  bile  discharged  by  vomiting  in  largo  quantities  during 
the  purgative  action  of  the  same  mercurial ;  and  how  any 
one,  conversant  with  this  tendency,  undisputed  until  recently, 
of  calomel  to  increase  the  secretion  of  bile,  I  am  utterly  at  a 
loss  to  conceive.  How,  if  it  is  not  absorbed,  can  you  account 
for  its  action  on  the  gums,  or  the  dissolution  of  plastic 
deposits,  its  removal  of  serous  effusions,  its  power  of  rapidly 
healing  chancre,  its  unquestioned  ability  to  cure  iritis? 
How  can  we  otherwise  account  for  salivation  produced  by 
mercury  introduced  into  the  system  by  inunction  or  hypo¬ 
dermic  injection  ?  Let  us  summon  to  the  stand  as  a  witness 
of  great  reliability  and  experience  the  distinguished  Head¬ 
land,  than  whom  there  is  no  higher  authority  in  our  profes¬ 
sion.  In  his  admirable  work  “  On  the  Action  of  Medicines 
on  the  System,”  this  great  light  states  that  “  Mercury  is 
absorbed  into  the  blood,  and  'particularly  tends  to  the  liver ,  bowels , 
salivary  glands  and  skin .”  He  classes  it  among  the  “  true 
cholagogues.”  He  says  that  <c  Mercurials  increase  more  or 
less  all  the  secretions,  and  even  if  we  had  no  direct  proof  of 
their  action  on  the  liver  we  might  almost  have  affirmed  that 
they  especially  increase  the  secretion  of  bile  from  the  obvious 
way  in  which  bilious  symptoms  yield  to  their  action.  But 
we  have  direct  proof  of  this.  M.  Bucklein  has  made  some 
careful  experiments  on  a  dog.  Having  given  it  Mercury,  he 
cut  down  upon  the  hepatic  duct  and  collected  the  secretion 
and  subsequently  analyzed  it.  He  found  that  the  bile  was 
increased  and  that  mercury  was  found  in  it.” — [Page  297.] 
Again  he  says :  “  Mercury,  sulphur  and  iodine  have  been 
, chemically  detected  in  the  perspiration.  It  has  happened 
when  a  course  of  mercury  has  followed  the  administration  of 
sulphur  that  parts  of  the  skin  have  turned  black  from  tha 
formation  of  sulphuret  of  mercury.” — [Page  301.]  He  also 
says  that  “  mercury  has  been  detected  in  the  urine.” — 
[Page  306.] 

Let  us  now  consult  another  learned  and  high  authority, 
Pereira.  He  states,  in  his  great  work  on  Materia  Medica 
and  Therapeutics — [American  Edition,  1852,  volume  1,  page 
773] — that,  “  By  the  external  or  internal  use  of  Mercury 
this  metal  becomes  absorbed ,  and  is  subsequently  either 
deposited  in  some  of  the  solids  of  the  body ,  or  thrown  out  of  the 
system  by  some  of  the  excretories.  The  accuracy  of  the 
statement  is  proven  by  the  following  facts :  1st.  Mercury 
has  been  detect o  i  in  the  blood  by  Zeller,  Buckner,  Schubartli, 
Colson  and  Dicterich.  It  appears  to  be  in  such  intimate 
combination  with  the  vital  fluid  that  it  cannot  be  recognized 
by  the  ordinary  tests.  Destructive  distillation  is  in  most 


cases  necessary  for  its  detection.  2nd.  Mercury  lias  been 
found  in  tlie  secretions,  viz :  in  the  perspiration,  in 
the  saliva,  in  the  gastro-intestinal  secretion,  the  bile, 
the  urine,  and  in  the  fluid  of  ulcers.  3rd.  Mercury  has 
been  found  in  the  organic  solids,  viz  :  in  the  bones,  brain, 
synovial  capsules,  pleura,  humours  of  the  eye,  cellular  tissue, 
lungs,  Ac.  In  what  part  of  the  system  reduction  is  effected 
has  not  been  made  out.” — [Volume  1,  pp.  773-74.] 

“  The  secretion  of  bile  (by  mercury)  is  promoted.” — 
[Page  774.] 

Who  has  not  seen  in  the  old  treatment  of  Remittent 
Fevers,  that  just  as  soon  as  the  gums  were  touched  by  mer¬ 
cury  the  liver  poured  out  large  quantities  of  blackish,  green, 
viscid  bile,  which  invariably  denoted  a  favorable  solution  of 
the  disease  ?  Rut  let  us  go  on  with  the  authorities.  Our 
own  illustrious  American  Professor,  Wood,  remarks  as 
follows,  in  his  able  work  on  Therapeutics  and  Pharmacology 
• — [2nd  vol.,  page  243] — “  That  mercury  is  absorbed  is 
proved  by  the  following  facts  :  When  rubbed  upon  the  skin 
it  in  parts  appears.  After  administration  it  has  been  de¬ 
tected  by  chemica  itests  in  the  blood,  saliva,  perspiration, 
bile  and  urine,  and  is  said  to  have  been  found  in  a  metallic 
state  in  the  brain,  bones,  cellular  tissue,  lungs,  &c.  Infants 
affected  with  syphilis  are  asserted  to  be  treated  effectually 
by  the  administration  of  mercurials  to  the  nurse,  &c.  The 
hepatic  secretion  is  often  energetically  stimulated,  especially 
when  the  medicine  is  administered  internally.  There  is  no 
cholagogue  which  approaches  in  efficiency  some  of  the 
preparations  of  mercury.  A  true  cholera  morbus,  with 
copious  vomiting  and  purging  of  bile,  is  not  unfrequontly 
induced  by  a  largo  dose  of  calomel.” 

State,  in  his  Therapeutics  and  Materia  Medica  (Vol.  2,  p. 
731),  cites  numerous  and  convincing  proofs  of  the  absorption 
of  Mercury.  After  mentioning  the  experiments  of  Schobarth 
and  Zeller,  before  mentioned,  he  says:  “  Oesterlen  found 
minute  globules  of  Mercury  in  the  pancreas,  liver,  spleen,  lungs, 
heart,  mesenteric  glands,  kidneys,  &c.,  and  also  in  the  urine,  bile, 
: milk  and  saliva ,”  (p.  782).  “  Among  the  proofs  of  mercurial 

absorption  by  man,  tlie  following  may  bo  selected  :  In  1810 
Brickmann  published  an  account  of  a  lady  who,  a  year  after 
being  salivated,  having  become  heated  by  violent  dancing, 
mercurial  stains  appeared  on  her  breast,  and  metallic  mercury 
was  found  in  her  linen.  In  1813  Jourda  collected  a  quantity 
of  mercury  from  the  urine  of  a  syphilitic  patient  who  was 
taking  this  remedy.”  b 'title  quotes  other  authorities  to  simi¬ 
lar  facts,  and  treats  at  length,  fully  and  clearly,  of  the  effects 


G3 


of  medicinal  doses  of  mercurial  remedies,  their  action — sim¬ 
ilar  to  that  given  by  others — producing  liquid  and  billious 
discharges,  Ac.”  I  might  go  on  and  cite  additional  authori¬ 
ties,  numerous  and  high,  in  corroboration  of  the  observa¬ 
tions,  experiments  and  statements  of  those  I  have  given  ;  but 
can  any  honest  and  unprejudiced  man  require  further  proof 
of  the  position  that  mercury  is  absorbed  into  the  blood,  and 
is  a  cholagogue  ? 

The  following  additional  quotations  from  Headland  are 
well  worthy  of  introduction  here  :  “As  hematic  medicines 
mercurials  have  a  double  action.  They  counteract  in¬ 
flammation  in  general,  and  the  poison  of  syphilis  in  particu¬ 
lar  (p.  325).  On  account  of  the  durable  and  effectual  naturo 
of  its  action,  mercury  is  of  great  use  in  preventing  the 
process  of  effusion ,  and  in  causing  the  absorption  of  effused 
'products.  It  is  thus  employed  in  pleurisy ,  and  in  other  mem¬ 
braneous  inflammations.  Next  to  these  it  is  most  useful  in  in¬ 
flammations  of  the  liver  and  brain.  It  is  inferior  to  antimo¬ 
ny  in  fevers  and  rapid  inflammations,  because  slower  in 
operation,  and  without  any  direct  action  on  the  nervous  sys¬ 
tem.  In  cases  of  primary  syphilis  mercury  is  by  far  the 
best  medicine  with  which  we  are  acquainted.  It  should 
be  used  in  all  cases,  except  where  there  is  deep-rooted  scrof¬ 
ula  or  marked  debility,  or  a  sloughing  and  irregular  con¬ 
dition  of  the  primary  sore.  It  should  always  be  given  in 
Iritis  ” 

“  Mercury,  being  unnatural  to  the  blood,  passes  at  length 
out  of  the  system  through  the  glands,  and  acts  as  an  elimi¬ 
native.  Like  antimony,  it  tends  to  increase  all  the  secre- 
'  tions  in  the  body.  But  whereas,  antimony  acts  especially 
on  the  secretions  of  the  skin  and  pulmonary  membranes, 
Mercury  tends  particularly  to  excite  the  functions  of  the 
liver  and  bowels,  being  cathartic  and  cholagogue 

On  another  occasion  Headland  writes  as  follows  :  “Another 
remedy,  of  a  different  kind,  has  been  used  in  all  the  diseasos 
in  which  quinine  is  admissible,  proving  in  some  cases  superi¬ 
or,  and  in  other  instances  second  only  to  it  in  its  beneficial 
action.  This  is  mercury  ;  and  in  remittent  and  yellow  fever  ; 
of  the  first  importance  in  dysentery  ;  employed  by  Hr.  Bail- 
lie  in  ague,  and  pronounced  by  him  to  be  superior  in  some 
cases  even  to  quinia.  In  small  doses  it  is  frequently  of  use 
in  cases  of  debility  and  scrofula.  And  mercury  is  a  chola¬ 
gogue,  i.  e.,  an  agent  which  is  known  to  have  the  enect 
of  promoting  the  secretory  function  of  the  liver.  lhus 
we  may  conceive  that  mercury,  not  given  in  excess,  or 
to  salivation,  may  operate  in  a  different  way  to  produce 
the  same  effect  as  quinine. 


If  the  connection  between  tonics  and  the  bile  were  actually 
established,  then  we  should  be  enabled  to  explain  a  mat¬ 
ter  which  otherwise  would  seem  difficult  to  understand — how 
it  is  that  small  doses  of  mercury  may  sometimes  act  as  tonics, 
though  we  know  that  the  ultimate  action  of  the  medicine, 
like  that  of  other  catalytics,  is  to  deterioate  the  blood.  Even 
in  scrofulous  and  enfeebled  cases  small  doses  of  blue  pills  or 
calomel  are  often  signally  useful,  and  not  prejudicial,  as 
is  sometimes  stated  by  those  who  confound  their  application 
with  that  of  mercury,  given  in  salivating  doses.  Under  such 
a  course,  when  judiciously  enforced,  we  may  see  the  dilated 
pupil  contract  to  its  normal  size,  and  the  pale,  enervated 
countenance  become  rosy  and  lively,  and  feel  the  weak  and 
compressible  pulse  to  become  hard  and  firm.  Perhaps  mer¬ 
cury  in  such  a  case  may  be  indirectly  tonic,  by  restoring  to 
the  blood  the  natural  tonic  principle  of  the  bile.” 

The  reactions  in  the  history  of  this  valuable  but  much 
abused  remedy  of  calomel,  the  fluctuations  of  professional 
appreciation  of  its  importance  and  value,  have  been  greater 
than  attach  to  any  other  remedial  agent  of  the  whole  p  rofes- 
sion.  But  when  we  remember  that  our  best  remedies  are 
those  which  have  been  most  abused,  shall  wTe  reject  the  good 
which  this  powerful  agent  is  capable  of  producing,  because 
its  abuse  has  been  so  great  ?  To  yield  to  the  unfoun¬ 
ded  prejudices  and  noisy  clamor  against  the  use  of  calo¬ 
mel,  which  are  becoming'  even  traditional,  that  to  use  it 
in  efficient  doses  places  a  practitioner  in  the  ranks  of 
old  fogyism,  and  behind  the  rapid  strides  of  medical  science, 
is  neither  manly,  philosophical,  nor  scientific.  That  physi¬ 
cian  is  wanting  in  the  stamina  of  real  manhood,  and  in  the 
sustaining  power  of  true  professional  devotion,  who  allows 
any  storms  of  surrounding  circumstances,  or  any  prejudice 
or  tradition,  however  honored  by  time  or  authority,  to  stand 
between  himself  and  a  judicious  trial  of  legitimate  means, 
whether  of  ancient  origin  or  modern  growth,  in  combatting 
disease  and  saving  life.  I  admit  that  much  prudence  and 
discrimination  should  be  exercised  in  the  administration 
of  mercurials.  I  confess  that  I  have  often  seen  them 
used  to  such  an  excess  in  the  bowel  complaints  of  children, 
and  other  diseases  of  infancy  and  adult  age,  as  to  produce 
that  deterioration- of  the  system,  that  disintegration  and  dis¬ 
organization  of  the  blood,  that  entailed  dropsy,  consump¬ 
tion,  and  other  protracted  and  wasting  affections,  which 
•either  greatly  injured  the  constitution  or  ended  in  death. 
•Such  ignorance  and  mal-practice  in  the  use  of  this  effective 


65 


weapon,  while  inexcusable,  have  contributed  greatly  to  that 
discrepancy  in  the  results  of  its  administration  which  has 
made  the  calomel  treatment  objectionable  to  so  many  good 
men.  But  when  we  learn,  as  learn  we  must,  more  of  its 
mode  of  action,  as  well  as  of  its  remarkable  capabilities  and 
most  valuable  adaptations  in  subduing  many  of  the  most 
fatal  diseases  of  the  human  system,  it  is  reasonable  to 
suppose  that  less  ignorance  will  guide,  and  less  prejudice 
and  danger  attend,  its  use.  The  authentic  accounts  from 
high  authorities  of  the  happy  effects  of  large  doses  of  a 
scruple  and  upwards  of  calomel  in  cholera  morbus,  epi¬ 
demic  dysentery,  cholera,  <&c.,  are  only  equalled  in  striking 
import  by  the  well-attested  records  of  the  cure  of  that  terri¬ 
ble  enemy  of  infantile  life,  membraneous  croup,  by  similar 
doses,  during  the  last  twenty  years,  in  the  practice  of  most 
distinguished  physicians  of  New  York  city  and  elsewhere. 
The  introduction  of  the  calomel  treatment  m  croup  has  been 
credited  to  Dr.  Bay,  of  Albany,  New  York  ;  but  Dr.  Hamil¬ 
ton,  in  his  work  on  mercury,  published  early  in  the  present 
century,  regards  it  simply  as  the  American  treatment,  and 
says  it  spread  from  America  to  England.  This  celebrated 
author,  wrho  has  written  more  strongly  against  the  gen¬ 
eral  use  of  calomel  than  almost  any  writer  prior  to  those 
Modern  Revolutionists,  Todd,  Bennett  &  Co.,  extolled  its 
action  in  large  doses  nevertheless  in  genuine  croup.  He 
says  that  “  no  relief  whatever  has  been  afforded  by  that 
medicine  (calomel),  imles  copious,  dark-green  colored  stools, 
like  boiled  spinach,  have  been  discharged,  and  that  it 
,  requires  large  and  repeated  doses  of  the  medicine  to 
produce  that  effect.  For  example,  to  a  child  seven  years 
old,  one  hundred  and  thirty-three  grains  were  given  within 
sixty  hours.”  He  says,  moreover,  that  “  in  the  only  cases  in 
which  this  medicine  has  failed  under  the  author’s  direction 
(being  in  the  proportion  of  four  out  of  fifty),  no  evacuation 
through  the  bowels  could  be  produced.”  “  It  is  extremely 
difficult,”  remarks  Professor  Hamilton,  “  to  explain,  in  the 
first  place,  the  safety  with  which  a  hundred  and  thirty-three 
grains  of  calomel  could  be  given  in  this  climate  '(England) 
within  sixty  hours  to  &  child  of  seven  years.  Secondly,  the 
relief  which  has  invariably  followed  the  discharge  of  the 
dark-green  colored  evacuations.” 

Nowhere  have  I  known  or  seen  recorded  such  remarkable 
success  in  the  treatment  of  croup,  nor  the  necessity  so 
strongly  enforced  of  a  pre-requisite  to  success  of  a  con¬ 
tinuance  of  the  treatment  until  relief  follows,  or  until  there 
appears  those  free  evacuations  of  the  stools  just  described. 


GG 


I  and  told  that  scruple  doses,  and  larger,  are  common  in  Kew 
York  among  the  best  practitioners,  who  treat  croup  success¬ 
fully,  although  no  published  allusions  are  made  to  such  treat¬ 
ment,  owing  to  the  prejudice  against  large  doses  of  calomel, 
both  within  and  without  the  profession. 

The  administration  of  heroic  doses  of  this  mineral  under 
suitable  cases  and  stages  of  disease  reoeived  a  revival  in  the 
example  and  endorsement  of  the  illustrious  James  Johnson. 
He  contracted  a  violent  attack  of  dysentery  while  hunting 
on  the  banks  of  the  Ganges.  His  medical  attendants  put 
him  upon  the  usual  treatment  of  small  doses  of  calomel, 
combined  with  opium,  together  with  mercurial  inunction. 
This  was  continued  for  two  days,  but  he  constantly  grew 
worse  and  worse.  He  says,  in  his  own  graphic  account,  that 
at  this  stage  :  “  The  Surgeon  endeavored  to  cheer  me,  with 
the  hope  of  ptyalism,  which,  he  assured  me  would  alleviate 
my  sufferings.  I  then  had  no  local  experience  in  the  com¬ 
plaint  myself.  As  the  night  advanced,  all  the  symptoms 
became  aggravated,  and  I  was  convinced  that  a  fatal  termi¬ 
nation  must  ensue  unless  a  speedy  relief  could  be  procured. 
I  had  no  other  hope  but  on  ptyalism,  for  my  medical  friend 
held  out  no  other  prospect.  I  sent  for  my  assistant,  and 
desired  him  to  give  me  a  scruple  of  calomel,  which  I  instantly 
swallowed,  and  found  that  it  produced  no  additional  uneasi¬ 
ness  ;  on  the  contrary,  I  fancied  it  rather  lulled  the  tormina. 
But  my  sufferings  were  great — my  debility  was  increasing 
rapidly,  and  I  quite  despaired  of  recovery  !  Indeed  I  looked 
forward  with  impatience  to  a  final  release !  At  four  o’clock 
in  the  morning  I  repeated  the  dose  of  calomel,  and  at  eight 
o’clock  (or  between  sixty  and  seventy  hours  from  the  attack) 
I  fell,  for  the  first  time,  into  a  sound  and  refreshing  sleep, 
which  lasted  till  near  midnight,  when  I  awoke.  It  was  some 
minutes  before  I  could  bring  myself  to  a  perfect  recollection 
of  my  situation  prior  to  this  repose  ;  hut  I  feared  it  was  still 
a  dream,  for  I  felt  no  pain  whatever  !  My  skin  was  covered 
with  a  warm  moisture,  and  I  lay  £or  some  considerable  time 
without  moving  a  voluntary  muscle,  doubtful  whether  my 
feelings  and  senses  did  not  deceive  me.  I  now  felt  an 
uneasiness  in  my  bowels  and  a  call  to  stool.  Alas,  thought 
I,  my  miseries  are  not  yet  over.  I  wrapped  myself  up  to 
prevent  a  chill,  and  was  most  agreeably  surprised  to  find7 
that  with  little  or  no  griping,  1  passed  a  copious,  feculant 
billious  stool,  succeeded  by  such  agreeable  sensations — acqui¬ 
sition  of  strength,  and  elevation  of  spirits — that  I  ejaculated 
aloud  the  most  sincere  and  heartfelt  tribute  of  gratitude  to 
Heaven  for  my  deliverance.” 


67 


I 


In  addition  to  the  slower  and  alterative  action  of  calomel 
in  minute  doses,  there  seems  to  be  a  growing  belief  that 
when  given  in  larger  and  purgative  doses  it  is  attended  with 
very  decided  sedative  powers.  Dr.  Learning  and  others  claim 
for  it  distinct  sedative  virtues,  and  the  power  to  produce  a 
profound  and  favorable  impression  through  the  sympathetic 
system  of  nerves  upon  those  violent  forms  of  disease  common 
to  Southern  localities.  But  whether  it  acts  mostly  through  ab¬ 
sorption  into  th^e  blood,  or  in  no  small  degree,  according  to  the 
theory  of  the  reflex  action  enunciated  by  Marshall  Hall,  and 
which,  through  the  investigations  of  Brown  Sequard  and 
others,  have  solved  many  intricate  physiological  and  patho¬ 
logical  problems,  as  many  are  assured,  it  cannot  be  denied, 
that,  whether  given  in  smaller  or  larger  doses,  as  existing 
indications  and  changing  circumstances  should  always 
decide,  its  use  is  indispensable  in  the  treatment  of  a  large 
number  of  the  prevailing  congestions,  inflammations  and 
other  affections  of  this  latitude. 

Finally,  in  relation  to  the  modern  treatment  of  fever  and 
inflammation,  I  have  yet  to  learn  of  a  single  advocate  of  the 
depletory  system  who  denies  the  influence  of  the  conservative 
powers  of  nature  in  disease,  or  rejects  the  judicious  adminis¬ 
tration  of  food  and  brandy.  No  considerate  physician  has 
ever  denied  that,  when  high  fevers  have  been  removed  and 
inflammatory  action  subdued  and  other  indications  are 
favorable  to  alimentation,  or  when  the  system  is  much  re¬ 
duced  either  by  acute  affections,  or  slow,  lingering  diseases, 
suitable  food  and  stimulation  is  not  only  proper  but  neces¬ 
sary.  But  that  food  and  stimulants,  except  in  limited 
quantities,  are  contra-indicated  under  opposite  states  and 
conditions,  is  a  fact  sustained  by  the  general  voice  of  the 
profession  in  this  country  and  in  Europe.  The  sensible 
physician  never  opposes,  but  always  seeks,  the  aid  of  nature ; 
the  expectant  system  has  its  comparative  value,  and  its 
remedies  are  sometimes  appropriate  and  sufficient ;  and  ali¬ 
mentation  and  stimulation  have  their  subordinate  and  proper 
positions  in  the  catalogue  of  remedial  agents  ;  but  singly ,  or 
in  any  combination ,  such  influences  and  agents,  when 
brought  to  bear  upon  concentrated  malaria,  or  directed 
against  the  higher  grade  of  our  congestive  fevers  and 
inflammations,  are  nothing  more  than  mere  “  medita¬ 
tions  upon  death.”  The  disciples  of  a  judicious  antiphlo¬ 
gistic  treatment  are  among  the  foremost  in  recognition  of 
the  influences  named ;  they  are  ever  ready  and  anxious 
to  consult  with  nature,  and  to  admit  its  full  power  in 
I 


68 


the  class  of  self-limited  diseases,  and  that  under  this  self- 
limitation  numerous  cases  will  progress  to  recovery  without 
medication.  But  all  this  is  no  evidence  that,  even  in  self¬ 
limited  diseases,  judicious  treatment  is  not  indicated — not 
alone  to  cut  short,  modify,  and  control  disease,  but  also  to 
prevent  unnecessary  complications,  and  sometimes  to  save  life. 

If  the  medical  profession  has  no  higher  functions  to  per¬ 
form  than  a  mere  skilful  manipulation  of  the  Liquor 
Distillery,  as  some  have  doubtless  concluded  who  have  read 
Dr.  Norcoufs  address,  it  is  a  mere  mockery  to  the  community, 
and  our  science,  instead  of  being  humane  and  noble,  as  we 
have  claimed  it  to  be,  is  worthy  of  no  higher  devotion  than 
such  as  the  cook  and  distiller  can  bestow.  If  the  views  we 
have  honestly  sought  to  combat  are  correct,  better,  much 
better,  would  it  be  to  disorganize  all  our  medical  organiza¬ 
tions,  break  up  our  Medical  Schools  and  Universities,  and 
burn  up  our  Medical  Journals  and  Books.  And  then,  in 
penitential  sorrow  for  the  offences  of  our  past  professional 
devotion,  to  come  forward,  in  a  spirit  of  humiliation  and 
mortification,  to  admit,  that  the  advancement  of  medicine 
and  the  reputed  glories  of  our  profession  are  eclipsed  by  the 
triumphs  of  the  kitchen  and  the  achievements  of  the  distil¬ 
leries  and  drinking  saloons. 

While,  with  good  feelings  towards  Dr.  Norcoin,  I  am 
pleased  to  admire  the  ingenuity  and  ability  of  his  Address, 
yet,  I  am  induced  to  offer  these  opposing  views  and  ai- 
guments  from  a  sincere  conviction  that  his  doctrines  are  not 
in  accDrdance  with  the  teachings  of  medical  truth,  and  of 
true  medical  progress;  that  they  tend  to  throw  discredit 
upon  this  Society,  and  upon  the  experienced  practitioners  of 
the  State;  that  their  tendencies  are  to  bring  the  art  and  sci¬ 
ence  of  medicine  into  contempt  with  the  ignorant  and  vul¬ 
gar ;  and  are  pernicious  in  their  influences  upon  the  minds 
of  the  younger  men  of  the  profession. 

He  only  is  a  true  medical  philosopher  who  alike  interprets 
wisely  the  instructions  of  Nature  and  the  indications  of  dis¬ 
ease,  and  then  pursues  with  patience  and  firmness  the  path¬ 
way  illumined  by  their  radiant  beams.  Let  him  shun  equally 
the  dogmas  of  those  extremists  in  medicine  whose  enthu¬ 
siasm  or  prejudices  are  so  liable  to  lead  them  from  the  true 
paths  of  legitimate  practice.  Pursuing  the  even  tenor  of 
his  way,  seeking  only  for  truth,  let  him  reject  no  doctrine  be¬ 
cause  it  is  old,  nor  adopt  any  theory  because  it  is  arrayed  in 
the  captivating  charms  of  novelty.  Such  a  course  may  be 
slow  to  secure  public  attention  and  patronage,  and  may"  not 


< 


strike  the  admiration  of  the  fickle  multitude  ;  but  in  the 
end  it  will  secure  that  kind  of  permanent  success  which  no 
sneaking  detraction  or  envenomed  envy  can  shake,  and  which 
the  superficial  and  wily  medical  demagogue  never  attains. 
His  name  will  be  enrolled  high  upon  the  list  of  noble  and 
faithful  physicians,  and  will  go  down  as  a  rich  and  proud  in¬ 
heritance  to  his  children  and  family.  Such  a  conservative 
course,  always  to  be  united  surely  with  personal  integrity 
and  honor,  may  not  satisfy  the  ambitious  aims  of  those  who 
are  not  content  with  the  gradual  advancement  of  themselves, 
and  the  sure  progress  of  a  well-settled  science.  It  may  not 
serve  to  calm  the  restlessness  of  those  who  are  ever  on  the 
alert,  either  to  weave  new  theories  themselves,  or  to  adopt 
the  new-fangled  doctrines  of  others — sometimes  for  lack  of 
judgment,  but  too  often  from  a  love  of  gain  and  notoriety. 
13ut,  founded  upon  the  rock  of  principle  rather  than  expedi¬ 
ency,  he  who  takes  this  rough  but  alluring  pathway,  and 
pursues  it  with  honesty  and  persistent  industry,  will  surely 
reach  that  higher  and  more  enduring  basis  of  prosperity  and 
renown  that  are  the  rewards  of  a  high  course,  and  which 
constitute  the  true  ends  of  effort  and  the  noble  objects  of 
life.  These  transcendental  extremists  may  not  do  as  much 
injury  to  society  and  medical  science  as  those  cunning,  un¬ 
dermining,  despicable,  medical  demagogues  in  our  own  regu¬ 
lar  ranks,  who,  under  the  authority  of  an  ill-gotten  diploma, 
smear  their  filthy  slime  on  their  daily  ways  of  humbuggery 
and  evil.  Their  motives  are  superior  to  those  of  these  pests 
of  the  profession;  but,  whatever  their  purposes,  they  do  more 
-  real  harm  to  science  and  the  profession  than  those  irregulars 
who  come  out  openly  against  us,  and  boldly  pitch  their  tents 
outside  the  garrison  of  Legitimate  Medicine. 


